Understanding the Fundamentals of Value-Based Care
March 14, 2022

The road to advancing healthcare may be unclear, but the many benefits of value-based healthcare are undeniable; they range from lowering costs and reducing medical errors to promoting healthy habits for patients and increasing patient satisfaction. 

The ongoing shift from “fee-for-service” to “value-based care” means that all healthcare providers must study and predict the needs of the patients they serve. The general goals of value-based treatment include three key pillars: improving the population's health, increasing patient satisfaction, and reducing costs. 

Defining Value-Based Care (VBC)

Value-based care (VBC) is a healthcare delivery model where providers—hospitals, laboratories, doctors, nurses, and others—are paid based on the health of their patients and the quality of care they provide. In a value-based healthcare model, healthcare professionals are paid based on quality and efficiency instead of a fee-based model where they are paid by volume, resulting in unnecessary procedures and higher costs. Quality of care includes patient outcomes, safety, and service, divided by the total cost of caring for a patient over time. 

In addition to agreed-upon payments, Medicare may also reward participating providers for effective and high-quality care. 

 In simple terms, value-based care means that healthcare professionals focus on preventing disease and identifying conditions in their early phases when they are easier and cheaper to treat, rather than treating patients after they become ill, which is costlier and leads to worse outcomes. This new paradigm makes healthcare work better for patients and providers by unifying everyone as one “team” and aligning incentives.

What is an Accountable Care Organization?

In an accountable care organization (ACO), physicians, hospitals, and other healthcare professionals form a networked team to provide the best-coordinated care at the lowest possible cost. Each team member shares the risks and rewards and improves access to care, quality of care, and patient health outcomes while reducing costs. ACOs are networks of doctors and healthcare facilities that share financial and medical responsibility for providing coordinated patient care. ACOs were designed to support the healthcare industry's transition from fee-for-service to value-based healthcare. VBC models are based on a robust, team-oriented approach, often led by the patient's primary care physician.

While quality care can be provided in any model, the difference in how providers are paid, combined with how patient care is delivered, offers the opportunity to improve healthcare and save money in a VBC environment. It simply means being aware of certain things that cost patients the most, such as hospitalizations, trips to the emergency room, or brand-name drugs, and then using a holistic patient care approach to reduce those costs. 

Transforming the healthcare system will take time as every shift faces its own challenges. A successful move to value-based care will be difficult without doctors on board. Therefore, incentives will be needed to motivate physicians. Some of these incentives include; developing care management systems to improve population health and providing physicians with the necessary tools to facilitate the shift, such as data analytics engines, and expanded services. 

Nevertheless, the shift from fee-for-service to value-based care has proven over time to be the most effective way to reduce healthcare expenditures while improving the quality of care and assisting people in living longer, healthier lives.