Value-Based Care: A Transformative Approach for Healthcare Providers

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As opposed to other western countries, the United States spends a substantial amount of its gross domestic product on the healthcare industry. However, there still seem to be several loopholes in the accessibility and affordability of healthcare in the US, even today. 

Technological integration in healthcare seeks to not only curate innovative strategies for better administrative management of clinical workflows, it aims to make healthcare more accessible and therefore affordable for the population. 

Technologies such as Telehealth have thus, become an integral part of healthcare provision, posing as a unique avenue for expanding healthcare delivery access across larger geographical locations. 

What is Value based Care? 

The Affordable Care Act, a set of reforms passed in 2010, were aimed at improving health insurance laws for affordable patients, but also set into motion, the concept of value-based care. 

The Act required the US healthcare industry to focus on experimenting with newer models of healthcare delivery and focusing on shifting from the former volume-dependent healthcare reimbursements to a more value-based reimbursement protocol. 

This, therefore, set into motion the strife to modernize current healthcare practices and streamline healthcare initiatives to expand accessibility. 

Simply put, value-based healthcare focuses on charging patients for the quality of healthcare services rather than just the quantity. This seeks to fine tune healthcare delivery protocols towards the singular goal of improving quality of life and disease status. 

Value-based care vs. Fee for service  

A fee for service model of healthcare reimbursement focuses on allowing healthcare providers to charge for the patients according to the number of procedures performed. This influenced several healthcare physicians to order unnecessary laboratory tests, and imaging procedures, charging the patient for even those services that added little to no value in treating the patient’s disease or managing their symptoms. 

Ultimately this resulted in physicians treating more patients and charging heavy unbundled amounts for each service desperately.  The government was paying hefty amounts for reimbursements in the healthcare industry to treat patients through the fee for service model. However, healthcare outcomes remained the same. There was also no improvement in expanding healthcare accessibility and therefore, proved disadvantageous in improving overall population health for the country. 

The value-based care model was created to bring these soaring healthcare costs down, and allowing physicians to charge only for those services that are relevant to the disease treatment protocol. This influenced ordering for only relevant tests and imaging procedures since extra procedures will not be charged for. 

Through the value-based care model, patient is able to receive targeted treatment for healthcare issues, thereby, improving health outcomes and through healthcare affordability, improving the access to essential healthcare. 

What it means for Providers? 

With value-based care models healthcare organizations and physicians are incentivized to improve healthcare delivery according to three core metrics: quality, cost and equity. 

These metrics are important to comprehend whether physicians are focusing on providing effective healthcare to patients or are more focusses towards getting paid better. By forgoing improvement in these metrics, organizations may lose possibilities of bonuses or other incentives to improve healthcare delivery. 

Quality 

Quality of healthcare can be determined by the effectiveness and relevance of treatment protocols devised for a certain disease.  

Additionally, it is also imperative that each treatment provided possess a sense of “patient centredness”, that is, patients’ wishes and preferences are respected throughout the care treatment. Whilst ensuring patients remain comfortable throughout the treatment process, it is also important to maintain timeliness of treatment, without unnecessarily elongating treatment duration for the patient. 

Cost 

Value-based care allows physicians to be incentivized or rewarded for cutting costs or maintaining charges for certain procedures for all patients. 

This means that physicians can benefit from cutting back unnecessary or high costs and ensuring a standard price point for all major procedures and treatments. 

Equity 

Health equity is a major aspect of value-based care. It encourages physicians to provide accurate and efficient healthcare to patients across all races, genders and ethnicities, ensuring a seamless balance of healthcare accessibility and treatment efficiency. 

Regulatory bodies now incentivize the provision of quality healthcare in order to reduce social disparities in healthcare provision, and therefore, also improve the exploration of productive treatment modalities for underserved social groups.  

Conclusion 

Value-based care prioritizes the formation of health reforms and laws that focus primarily on patient-centered health outcomes. It helps minimize social disparities in healthcare provision, improves the efficiency of healthcare provided across all social subcategories and advances medical research by incorporating all social subclasses to create targeted patient treatments. 

Rewarding value-based care helps healthcare providers be encouraged towards focusing on the larger goal of expanding healthcare accessibility and efficiency and improving quality of life through the management of patient symptoms. 

By prioritizing value-based care, the US healthcare can effectively shift from becoming profitable, to becoming more result-oriented in futuristic medicine.