Is value-based care a sustainable approach to healthcare delivery?

The US health care system is under enormous pressure as the county’s population ages and chronic conditions become commonplace.

The traditional fee-for-service model, based on incentives for the volume of treatment over the “right” treatment, is increasingly unsustainable.

Value-based care, linking processes, structures, and reimbursement to patient outcome, is viewed as an improved and sustainable healthcare model for the 21st century.

Rebuilding health care systems

Rebuilding healthcare systems by giving patients a better quality of life is what value-based care is all about. Prioritizing the quality of treatment over quantity, eliminating waste and duplication, and delivering more care for less spend.

A transition to value-based care brings tangible, widespread benefits to payor and health care organizations and patients, including improved clinical outcomes and a reduction in costly, care-related complications. Including reduced patient readmission rates and emergency care episodes decreased, in addition to eliminating unnecessary surgeries.

For value-based health care to be effective, it requires realigning incentives and changing payment structures, focusing on giving patients quality treatment that improves health outcomes, instead of doing as many treatments as possible to make more money.

Form Partnerships

The payor community needs to form partnerships with the health care organizations, the provider community and offer sustainable, long-term value-based care contracts and value-based payment models. Both providers and payors need to develop an approach to integrate better social factors that are determinants of health and reevaluate healthcare spending are vital steps to drive value-based care.

It’s possible to create value-based care models to deliver high-value care with all stakeholders engaged that reduce the overall costs of care while improving the quality of care. Care coordination is paramount and driven by patient outcomes. Primary care physicians need to be engaged and care based on coordination of care and outcomes.

Adapt Payment Models

Payors need to reimburse and pay the clinicians and health systems adequately for doing those services and hold providers accountable for the things they shouldn’t have been doing.

Robert Wood Johnson Foundation explained that strategies to ensure that payers take on insurance risk and health care providers take on performance risk include risk adjustment or risk stratification and risk corridors. Value-based health care payment systems should ensure that payers retain the insurance risk (the risk of patients’ health problems or more severe health problems) and that providers accept performance risk (the risk of delivering care for a particular health problem is delivered efficiently and effectively).

New value-based payment arrangements and benefits designs need to be developed and agreed to aligned for health systems, physicians, clinicians, and their patients to have easily accessible and affordable services. The evidence shows will make them healthier and improve their quality of life. The cost of care needs to be reflected in the outcome.

Obstacles to adoption

Fee-for-service payment structures and regulations are significant obstacles preventing the adoption of value-based health care. Then layer on care unit alignment and pricing structures.

Today, reimbursement is tied to pieces of care delivered. Health care providers are incentivized to create more complex care to make more money vs. improved outcomes.

Health care needs to be organized around the patient, embracing the right technology and data access to improve the overall patient experience.

The Learning Curve

Health care providers at every step of the delivery system must have a clear strategy to drive implementation. The strategy needs to involve the mundane, from patient wait times and the obvious, unnecessary treatment to managing rising costs.

Organize Health Care Delivery Around Patients

Fee-for-service healthcare is organized around a fee structure, whereas value-based health care requires that care and the health care system be organized around the patient. This means shifting an organization’s culture and overall perspective.

As with the medical home, integrated practice units in hospitals encompass the full cycle of care and all patients with similar needs. It means moving away from generalists to more specialized care based on the patient.

The goal moves from treating the parts to treating the whole patient and improving the patient’s quality of life. This is a real culture shift for payors, providers, and the patient. The patient focuses care delivers benefits that the patient can see.

Embrace Technology

Embrace technology, the rapid advancement of health care technology offers the ability to reduce costs and improve health outcomes. From artificial intelligence (AI) to machine learning (MI), enhancing human readings of imaging to telehealth allows for greater efficiency and insights in health care delivery.

Technology offers the ability to improve communication, enhancing the relay of information instantaneously and accurately.

Break The Data Silos

Data in electronic medical records / electronic health records (EMR/EHR) is siloed and often lacking.

Break the data silos and give full access to data to enhance the insight into patient populations.

Integrated care requires datasets to be available to all health care providers to reduce the cost of care. By breaking the data silos, emergency departments, clinics, hospitals, and local health care providers have access to unseen connections to offer a more targeted level of care.

Develop strong data standards. Garbage in is still garbage out. Instilling strong data standards reassures patients and health care providers that the level of care they are delivering is warranted.

Sustainable Health Care Is Possible

Value-based- care is sustainable and can lower the cost of care while improving outcomes and quality of life if the health care systems culture is ready to adopt change and embrace new service models.

Primary care practices and health systems as a whole must be engaged and willing to adapt to the needs to address the social, economic, personal, and environmental factors that influence health status are or determinants of the health of their patients.

Value-based health care can address access to health care services and the quality of health services that can impact overall health.