What Tools Are Central to Value-Based Care?
By Ken Stoll
October 21, 2021
Like any business, the success of the healthcare industry is measured by both its cost-effectiveness and the value it provides to consumers. But what makes a dramatic difference in the healthcare arena is how value-based care can help improve patients’ health while still lowering costs and also upgrading physicians’ and other clinicians’ quality of life. Value-based care is less focused on a patient’s satisfaction, but on quantifiable improvements in their health.
The American Medical Association offers this list of six key components of a successful high-value healthcare system:
- A clear vision that focuses on the patient
- Professional, skilled clinicians
- A robust IT infrastructure across the board
- Broad access to care
- Payment models that reward improved quality of care over volume
The first tenet in value-based healthcare is understanding and identifying a set of patients whose health and related circumstances create consistent needs, and measuring the health outcomes and costs of care for each patient while developing comprehensive solutions. The fundamental difference between value-based healthcare and a more traditional fee-for-service (FFS) model is that under the FFS model, healthcare providers are compensated based on the number of services—office visits, lab tests, and other treatments—rather than the quality of care and the patient’s health outcome.
In a report published by the U.S. National Library of Medicine National Institutes of Health on defining and implementing value-based healthcare, researchers stated:
Value and patient satisfaction are also commonly confused. While the patient satisfaction movement has brought a much-needed emphasis on treating people with dignity and respect, the essential purpose of health care is improving health. Value is about helping patients. Satisfaction surveys ask patients, “How were we?” Value-based care providers ask, “How are you?”
To be effective, healthcare should be organized around groups of patients with a shared set of needs; for example, individuals with knee pain, or elderly people with chronic conditions like diabetes. This allows clinical teams to anticipate patient requirements and provide frequently needed services efficiently. This alleviates physician burnout and helps clinicians personalize care for individuals who may require different treatments. According to the Centers for Medicare and Medicaid Services (CMS), value-based care supports the aim of providing better care for individuals and populations at a lower cost. One of the tools promoted by the CMS’s Innovation Center (CMM) is an alternative payment model (APM) which rewards healthcare providers for delivering high-quality, cost-efficient care to a specific condition, a care episode, or population.
Another tool in the value-based care toolbox is an accountable care organization (ACO): a network of physicians and hospitals that share financial and medical responsibility for providing care to patients. For example, a middle-aged male patient visits a primary care doctor for chest pain, and because of factors like a family history of heart disease or obesity, the doctor may be concerned that the patient is at risk for cardiovascular disease. So, the physician coordinates care with a lab facility for blood work as well as a consultation with a cardiologist. After determining that the patient has a heart condition, a nurse and a dietitian are added to his dedicated care team, which works to treat him effectively without driving up unnecessary costs while focusing on improving and maintaining his health.
Most importantly, partnerships among clinical facilities and healthcare providers can expand as teams gain knowledge and the ability to work across more stages of the care cycle. Integrated teams may work with partners to use new technology to share information with patients with the joint goals of creating high value and better health outcomes that align with the interests of patients, family members, employers, and clinicians, allowing caregivers to provide the best possible care to meet each patient’s specific needs.