Traditionally, healthcare providers were getting a “fee for service” i.e they were reimbursed based on the number of visits or tests. There has been a change in the healthcare delivery model called “value-based” healthcare. Under this model, the health care providers are being paid based on the value they provide. The “value” is based on the health outcomes of the care that is provided to the patients.
There are many benefits of a value-based health care system, some of which include:
- Better health care at a lower cost
Value based healthcare is patient centric. Treating a chronic disease can be quite expensive but since this model is based on the quality of healthcare instead of the quantity of service provided, it enables patients to receive health care at lower cost.
- Controlling costs
Payers can control the cost by “bundling payments” for the patients care period, a few months/ a year or longer.
- Better health for the society
In USA health care expenditures account for about 18% of the GDP. The value-based model is expected to reduce the amount spent on healthcare. Less money is expected to be spent on hospitalizations and medical emergencies.
Value-Based Models
- Medical Homes:
The medical home refers to a coordinated and an integrated healthcare service to the patient. A delivery model called the patient centered medical home (PCMH) is one in which the primary, acute care and the specialty care are combined. They used electronic medical records (EMR’s) for sharing patient information, which helps them reduce redundant care/ tests.
- Accountable Care Organizations (ACOs):
ACOs are patient-centric organizations in which the doctors, hospitals and other healthcare providers work together as a team to provide coordinated care at a lower cost. Like the PCMHs, ACOs also share data amongst their teams. These were originally designed by the Centers of Medicare and Medicaid (CMS) in order to provide quality care of Medicare patients.
- Hospital Value-Based Purchasing (VPB):
The hospital VBP is a CMS program that provides incentives to acute-care hospitals for providing quality care to Medicare patients. This program improves the quality and safety of the patients as it tends to reduce adverse events in hospitals, and adopting evidence-based standards and protocol for patient care.
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