As healthcare costs continue to rise, modern healthcare systems have started to see a gradual shift towards value-based care payments which require medical care providers to be measured, rated, and scored. However, medical institutions face a challenge in adapting their structures for successful transitions.
In order to understand what value-based care really is, it is essential for organisations and healthcare providers to take a step back and see how it can affect them.
What Is Value-Based Care?
Value-based care is a payment model that rewards doctors and hospitals for treating patients in the right place, at the right time and with the appropriate amount of care. In layman terms, it is a quality-based system where the treatment/ doctor’s fee is determined by the outcome of the treatment.
This can be considered as a financial incentive to motivate healthcare providers to meet specific performance measures related to process quality and efficiency. The same way, it penalises weaker experiences, such as medical errors.
As healthcare costs continue to rise, value-based care is quickly gaining traction as an alternative to the traditional fee-for-service model. In a global survey by IPSOS, it was found that 49% Indians were not satisfied with the country’s health system. The traditional fee for service models has resulted in a conflict of interest from a patient’s perspective as the focus is on quantity rather than quality of service. Today, patient expectations have accelerated the adoption of value-based healthcare, where the focus is on clinical outcomes and service quality.
Value-Based Care vs. Fee-for-Service: What Changes?
The most significant difference between these two models is that in traditional fee-for-service, healthcare providers are rewarded by insurance companies and government agencies based on the volume of care delivered.
The payments are unbundled and paid separately, so the more tests and procedures they order, the more healthcare providers get paid. The problem with this method is that it encourages doctors and physicians to request tests and procedures that aren’t necessarily needed.
In opposition to fee-for-service models, in value-based care, doctors and physicians are incentivised to engage with patients to provide the right care based on the patient’s needs. They are encouraged to invest in new technology and break silos between different doctors, specialists, and surgeons by aligning their efforts with multiple providers.
Value-Based Care Model: How Does It Work?
Many healthcare organisations are redesigning their structure to support this new model. So, how does value-based care work in real life?
Well, there are several variations within this model. Here are the most common:
Accountable Care Organizations: ACO encourages coordination between all doctors, hospitals, and other healthcare providers involved in the care of the patient to improve quality and eliminate bureaucratic inefficiencies. Data sharing, including clinical and claims data, is essential to success.
Bundled Payments: Different from fee-for-service, in the bundled payment model, even if a treatment involves multiple providers, they are collectively reimbursed instead of individually paid.
Patient-Centred Medical Home: PCMH encourages the practices of a personal provider that, together with a qualified medical team, provides continuous, accessible, family-centred, comprehensive, compassionate and culturally-sensitive healthcare to achieve the best outcomes. This way, the patient is taken care of by a single doctor and team.
Is Value-Based Care the Future?
According to a OECD (Organisation for Economic Cooperation and Development) report, wasteful healthcare spending is common, and that up to one-fifth of healthcare spending could be placed towards better use. The report goes on to say, “Some patients receive repeated diagnostic tests or services, simply because the information is not shared across providers and that many patients receive overdiagnosis or overtreatment such as imaging for low back pain or headaches, cardiac imaging in low-risk patients, etc.”
The industry now recognises the need to move towards a value-based care model to provide better patient outcomes, lower costs, and a reduction in wasteful spending.
The transition from the current system of fragmented provider-based care to coordinated team-based care is a barrier to the adoption of value-based healthcare. Increasing pressures of healthcare spending, care costs and patient expectations have paved the way for the implementation of value-based healthcare, in which payment for care is tied to clinical outcomes and service quality.
Spending on healthcare is not always proportional to health outcomes. The cost of healthcare may vary depending on how efficiently resources are allocated and utilised in order to provide the best possible care.
Apart from the critical benefits of driving down costs and improving patient outcomes, value-based care can provide better health and better care for patients.
How to Accelerate Value-Based Care
With the pressure on for providers to shift their treatment models from fee-for-service to value-based care, the need to have a technology solution that can help them move quickly to a patient-centric care structure is paramount.
Modern application development platforms allow healthcare, life-sciences and pharmaceutical companies to rapidly build integrated omnichannel solutions that improve care communication, coordination and collaboration across physicians, nurses and patients. These systems help modernise affordable healthcare delivery by creating patient 360 view pulling in third-party unstructured data from sources such as wearables and clinical data (e.g., EHR, EMR). They can range from telehealth systems, patient portals, mobile healthcare applications and beyond.
The current system of healthcare in India operates in ‘silos’, which makes it difficult to provide the best possible healthcare outcome at the lowest possible cost. The fragmented system causes duplication of work and increases the cost while also reducing patient satisfaction. Value-based healthcare will bring together all modalities of care delivery to create a well-coordinated ‘continuum of care’.
By Subrato Bandhu, Reginal Vice President, OutSystems India
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly)
