What is Value-Based Care and why does it matter?

what is value-based care

Value-based care is a healthcare delivery model that focuses on achieving better patient outcomes while controlling costs. In this approach, the reimbursement for healthcare providers is tied to the quality and effectiveness of the care they deliver, rather than simply the quantity of services provided. The goal is to incentivize healthcare organizations and professionals to prioritize value, which includes factors such as improved patient outcomes, patient satisfaction, and cost-effectiveness. VBC is mandated by the government, employers, and commercial insurance carriers, leading to increased technology investments by healthcare delivery organizations.

How does VBC Work?

By shifting the focus from volume to value, value-based care aims to improve the overall quality of care while reducing unnecessary healthcare spending. It encourages healthcare providers to deliver evidence-based practices, engage in care coordination, and emphasize preventive care and chronic disease management. Providers are incentivized to meet specific quality metrics and improve patient outcomes, leading to better coordination, efficiency, and cost-effectiveness in healthcare delivery. This approach also emphasizes the importance of patient engagement and shared decision-making, ensuring that patients are actively involved in their own care and treatment plans.

Patient First Approach

The transition to value-based care involves various strategies and initiatives, such as alternative payment models, accountable care organizations (ACOs), bundled payments, and pay-for-performance programs. These models often involve financial incentives or penalties based on specific quality and outcome measures. By aligning financial incentives with patient outcomes, value-based care has the potential to improve healthcare quality, enhance patient experiences, and reduce healthcare costs. It promotes a more holistic approach to healthcare delivery that prioritizes the long-term health and well-being of patients.

Value-Based Payment Models Examples

Value-based payment models include various approaches such as pay-for-performance, bundled payments, shared savings, and capitation. Pay-for-performance ties reimbursement to achieving specific quality measures or outcomes. Bundled payments provide a single payment for an episode of care, incentivizing efficiency and coordination. Shared savings models distribute cost savings between providers and payers based on predefined targets. Capitation involves fixed payments per patient to cover all necessary care.

The Need of an IT Infrastructure

By 2025, it is estimated that 45% of U.S. reimbursements will be tied to patient outcomes and quality of care. Health information technology and data analytics play a crucial role in supporting the implementation of value-based care by facilitating the collection, analysis, and sharing of patient data for improved care coordination, outcomes measurement, promoting patient engagement and informed decision-making.

VBC is Becoming Mandatory

VBC is mandated by the government, employers, and commercial insurance carriers, leading to increased technology investments by healthcare delivery organizations.

Evidence suggests that value-based care has the potential to improve patient outcomes and reduce costs, its impact can vary across different healthcare settings and regions. Continuous monitoring, evaluation, and refinement of value-based care initiatives are essential to assess their success and identify areas for improvement.

However, the successful implementation of value-based care requires collaboration among healthcare stakeholders, robust data infrastructure, and ongoing monitoring and evaluation to ensure the desired outcomes are achieved.

Persivia and Value-based Care

Persivia brings deep clinical knowledge and expertise along with a highly composable and extensible platform that employs, what Gartner calls, The Digital Health Platform approach to strengthen data analytics foundations, creating patient engagement moments, and deliver real-time ecosystem collaboration. Persivia CareSpace®  truly brings all pieces of value-based care together by curating data from 100s of patient sources and providing data-driven actionable insights and analytics at the point of care to drive best care and cost outcomes, and to improve efficiency.