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U.S. healthcare, while overall excellent, is often too pricey, inefficient, and varies in quality from hospital to hospital. These days, value-based care (VBC) reimbursement models are gaining momentum in the healthcare industry because they help facilitate a shift toward less expensive, and higher quality care for patients.
As a result, many hospitals are starting to move away from traditional fee-for-service, or pay-for-performance, models and toward VBC care models. In fact, over the past eight years, the number of U.S. states and territories that implement VBC programs has spiked – rising from 3 states in 2011 to 48 as of 2018.
Traditional fee-for-service (FFS) models pay providers retrospectively for the quantity of services delivered. Over the past 10 years, there has been a shift in healthcare to focus on care quality and patient outcomes: quicker recoveries, fewer re-admissions, lower infection rates, and fewer medical errors. Enter value-based care: a reimbursement model that rewards healthcare providers with incentives based on the quality of care they provide to patients. In this way, healthcare providers that are high-performing and effective are rewarded with improved reputations and enhanced reimbursement payments.
There are a wide variety of ways that providers can implement value-based care in their organizations, but here are two of the more popular types:
Three states in particular—New York, Pennsylvania, and Vermont—are noteworthy for the broad scope of their value-based care initiatives and willingness to embrace payment models that involve shared risk.
There is still a bit of hesitation or delay in implementing value-based care models, partly because it means physicians must adapt to new methods of care delivery and reporting. Whether providers like it or not, this industry-wide movement toward value-based care is picking up traction, so it is critical for providers to embrace the upcoming change. Here are a few ways your organization might shift, with a new reimbursement process in place:
It can be hard to benchmark your organization's ability to deliver value-based care. Key performance indicators like supply chain spending, wait times, and readmission rates can give your practice quantifiable achievement goals, but if you want to see where you stack up against your competitors, it might make sense to invest in a software platform that allows you to compare your hospital's scores to that of your competitors, your region, or even the national average. Software platforms like Definitive Healthcare can help you access actionable intelligence on the healthcare ecosystem to help you grow your network, retain patients, and understand where you rank compared to the competition.
Want to understand how many members a given accountable care organization has, or how large the ACO's patient population is? Hoping to understand which hospitals and physician groups are currently participating in BPCI programs (Model 2, 3, 4, Advanced, or CJR bundled payment)? Definitive Healthcare can enable you search for, and fully understand, which hospitals and providers are participating in value-based care programs across the U.S., and benchmark your progress against competitors with: