You may have heard about a shift in healthcare from traditional fee-for-service-based care to value-based care. But, what’s the difference?

 

Traditional healthcare: Patients (and their employers), pay for a service provided by a healthcare professional– regardless of whether they were diagnosed or cured.

 

Example: John visits the doctor with severe congestion and coughing. The doctor sends him for blood tests and an x-ray – each at separate facilities. Once the doctor receives the results, she prescribes an antibiotic. John paid the copay at the doctor; then receives two separate bills from the blood-testing facility and the x-ray facility.

 

Value-based healthcare: Patients (and their employers), pay based on the patient’s health outcomes, and providers are rewarded for helping patients improve their health – based on evidence.

 

Example: Same scenario, except this time the care is coordinated, and John receives one bill for all services, and his doctor is paid once he’s healthy and she follows up with John to ensure he’s taking preventive steps to get and stay healthy going forward.

 

The idea behind value-based healthcare is to improve the quality of healthcare, while increasing its efficiency. How? By encouraging medical professionals to get – and keep – their patients healthy vs. only treating them when their sick.

 

In fact, 29% of total U.S. healthcare payments in 2016 were tied to alternative payment models (APMs), such as value-based healthcare, with the Department of Health and Human Services planning to move 50% of traditional Medicare payments to value-based payment models by the end of this year.

 

How Value-Based Healthcare May Benefit You – And Your Employees

 

1. Increases payment efficiency. Value-based care bundles payments for a person’s complete care vs. paying multiple medical professionals for services rendered. This is not only more convenient for the patient, but also enables you to better anticipate and prepare for costs.
    

2. Decreases overall costs. Because the focus shifts to helping people get and stay healthy, risk is reduced and the population experiences fewer claims, which lowers overall costs
    

3. Enhances employee health. Finding the time and the money to manage chronic conditions like high blood pressure, diabetes, cancer and the like, can be challenging, to say the least. With value-based care, the focus shifts to helping people quickly and efficiently recover from these ailments – and hopefully, avoid them altogether. This translates to fewer visits to the doctor, fewer tests, fewer procedures, and focuses on enhancing a person’s overall health.

 

Interested in learning more about value-based healthcare and understanding if it may be the best choice for you and your employees? Reach out today.

 

Sources: Value-based care: A new, patient-centered approach to health care, What Is Value-Based Healthcare?, U.S. Health Care System Ties 29% of Payments to Alternative Payment Models