VALUE-BASED CARE: A WIN-WIN

A strong health benefits package can be a valuable component of the services that PEOs sell to small and mid-size businesses. Designing a health benefits program with your health care partners that is focused on driving cost-effective access to quality care can result in stronger businesses and healthier employees.

Value-based care has been a hot topic in the health care industry for many years. But what is it, and why is it still trending? While health care companies often agree on how to define value-based care, they don’t always implement it in similar ways.

UNDERSTANDING VALUE-BASED CARE

Value-based care is a health care delivery model that focuses on providing high-quality care while controlling costs. Traditionally, health care has operated on a fee-for-service basis, where providers are paid for each service they perform. In contrast, value-based care rewards health care providers for achieving better health outcomes for their patients. This model emphasizes preventive care, care coordination among health care providers, and personalized treatment plans based on individual health goals.

ADDRESSING QUALITY AND COST ISSUES

Two significant issues facing the American health care system are high costs and varying quality of care. The United States spends over $4 trillion on health care, fast approaching $5 trillion. This represents nearly $1 out of every $5 spent in the economy. Despite this high spending, the U.S. does not achieve the same quality outcomes, mortality benefits, and reduction in morbidity seen in some countries that spend less. The momentum behind value-based care is driven by its potential to improve outcomes, reduce health care costs, and enhance patient experience.

CHALLENGES IN IMPLEMENTING VALUE-BASED CARE

Implementing value-based care comes with several challenges:

Data Requirements: Value-based care requires extensive data to understand patients’ clinical conditions, risks and needs. Health care providers must collect and analyze this data to deliver personalized care effectively.

Care Coordination: Value-based care more often involves a team-based approach, than do traditional fee-for-service models. This team may include physicians, nurses, pharmacists, care coordinators, social workers and mental health professionals. Coordinating care among these providers is crucial for success.

Financial Risk: Providers are paid based on outcomes, and poor outcomes can result in financial penalties. Managing these risks can be complex and requires careful planning and execution.

BENEFITS OF VALUE-BASED CARE

Despite the challenges, the benefits of value-based care are significant. This model encourages preventive care, early intervention and chronic disease management – leading to better health outcomes for patients.

Example: Heart Failure Patient

Consider a patient discharged from the hospital after heart failure. In a value-based care model, the patient would be seen by a care team within a few days of discharge. The nurse would review discharge instructions and ensure the patient understands their diet and medication regimen. The nurse might identify the need for medication optimization and collaborate with the physician and pharmacist to reconcile medications. The patient would also be seen by a cardiologist and receive support from social workers and care coordinators to navigate appointments and understand the treatment plan. This comprehensive approach contrasts with some traditional fee-for-service care, where the patient might not receive such thorough follow-up.

BENEFITS FOR THE HEALTH CARE SYSTEM

Value-based care also benefits the health care system. By providing coordinated and personalized care, health care providers can help patients stay healthy at home, avoid unnecessary emergency room visits, and prevent rehospitalization. This approach reduces costs by eliminating unnecessary services, creating a win-win situation for both patients and the health care system.

THE FUTURE OF VALUE-BASED CARE

Value-based care represents a promising shift in the health care industry. By focusing on quality and cost control, this model has the potential to improve health outcomes, reduce expenses and enhance patient experience. Overcoming the challenges of data management, care coordination and financial risk is essential to realizing the full benefits of value-based care. As health care continues to evolve, value-based care will likely play a crucial role in shaping a more efficient and effective system.

Health care organizations that are poised to continue leadership in value-based care focus on key areas including: primary care, home services and technology.

Primary Care: Primary care is central to improving health care outcomes. By investing in primary care, health care organizations can enhance patient health while reducing the need for emergency room visits and hospitalizations.

Home Services: With an increasing number of people seeking health care services at home, more health care organizations now offer in-home support. This approach is crucial for maintaining patient health and ensuring continuity of care.

Technology: The power of technology improves patient engagement and outcomes. Through telehealth services, digital applications and data analytics, organizations like CVS Health® and Aetna® help create personalized care plans and provide tools that empower patients and care teams to achieve better health outcomes.

Health care organizations that demonstrate a commitment to value-based care are transforming the health care landscape. By focusing on preventive care, personalized treatment plans and better coordination among providers, we can create a more sustainable health care system that prioritizes patient health and well-being. It’s imperative that we all continue to innovate and focus on expanding services to deliver superior care and value to patients, customers, and the American health care system.