First in a Series
As healthcare reform inevitably moves forward, the concept of value-based care is one that physicians cannot afford to ignore.
At its core, value-based care focuses on rewarding good work rather than good workloads. It represents a wholesale shift by the federal government and private payers from paying for procedures and volume, to paying for outcomes and value.
The Times They Are A-Changing
What is driving the evolution to value-based care? In essence, employers, health plans and the federal government have expressed serious concerns related to:
– Perceptions of unsustainable costs
– Recognition that fee-for-service drives volume, not value
– Awareness of the potential for savings
– Current poor performance on quality indicators
These stakeholders have a desire for more value for the money spent.
Value-based care utilizes new payment models to reward better results in terms of cost, quality and outcome measures. These new payment methodologies include:
Accountable Care Organizations — The Affordable Care Act included a Medicare provision that allows healthcare providers to participate in accountable care organizations (ACOs). Utilizing shared savings/risk models, ACOs are incentivized to enhance quality, improve beneficiary outcomes and increase the value of care for a defined population across a broad scope of services.
Bundled Payments — Value-based care also seeks to incentivize coordination of care through bundled payments. For example, a cardiology group may partner with its local hospital to ensure coordinated care for patients admitted for angioplasty. The relationship might involve the hospital, the hospitalist, the discharge nurse, the cardiologist and even the primary care physician. A single payment is divvied up among the providers, with positive outcomes rewarded and negative ones penalized (legislation reduces Medicare payments for potentially preventable hospital readmissions).
Outcomes-based Reimbursement — This pay-for-performance financial model links a portion of a provider’s revenue to a quantifiable performance standard that reflects process or outcome criteria.
Patient Center Medical Home —In this financial model, a group of primary care providers agree to accept responsibility for managing the health of and delivering services to a defined population for a per-patient payment.
Get Ready for the Age of “Show-Me Medicine”
Another component of value-based care is what pundits are calling “show-me medicine.” Healthcare providers will increasingly be incentivized to track outcomes and quality metrics and, at some point, will be penalized for not participating in quality reporting programs (e.g., Medicare’s Physician Quality Reporting Initiative). Ultimately, payers will reward positive outcomes and adherence to best practices.
It is estimated that 50 percent of physician compensation in the next 10 years will be value-based. As that happens, physicians will certainly face new issues and opportunities.
Opportunities will arise because physicians are so integral to health care delivery and health care stakeholders will be concerned with physician success in a value-based world. As a result, physicians will have critical choices to consider. They will want to work with healthcare partners that fully and fairly enable an equitable approach to compensation. Equally attractive to physicians will be hospitals and health systems that provide clinical and business resources that promote effective collaboration — everything from care coordination and patient engagement tools to predictive models for health outcomes.
Value-based care is a complex issue requiring careful analysis of its potential impact on physician practices. Please look for our continuing blog articles on this topic.