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Monday, September 26, 2022
Home Healthcare RCM Old School meets New School Value-Based Care

Old School meets New School Value-Based Care

By Nehal S. Swami, Founder , RealTime Clinic, Inc.

In a rapidly changing healthcare landscape, it can be challenging to keep up with the latest buzzwords and trends. one phrase you may have heard lately is “value-based care.” but what does that mean, and how does it differ from the fee-for-service model that has long been the standard in healthcare?

Understanding Value-Based Care

Care based on giving value prioritizes providing high-quality treatment while simultaneously containing costs. In the traditional fee-for-service model, providers are paid based on the number of services they deliver. In contrast, value-based care providers are reimbursed based on the quality of their services.

Value-based care models seek to enhance patient outcomes while lowering overall healthcare expenditures. For instance, accountable care organizations (ACOs), medical homes, and bundled payments are all examples of value-based care models.

ACOs are responsible for coordinating medical treatment for their patients. They consist of primary care physicians, specialists, hospitals, and other professionals working in the medical field. The ACO model encourages providers to collaborate to improve patient care and eliminate unnecessary duplication of services.

Bundled payments are part of the value-based care model. This approach determines the price for a group of linked services, and service providers are obligated to offer all package services at or below this cost.

The Healthcare System Needs to Change

The state of our healthcare system in the United States is common knowledge. The costs are soaring, access to care is becoming increasingly complex, and the quality of care is frequently subpar. Something needs to change, and one approach to making that change is to provide care that is based on value.

A system known as value-based care is one in which healthcare practitioners are compensated not based on the quantity of treatment provided but rather on the quality of that care. This kind of system has the potential to improve access to care while both lowering costs and increasing the quality of care provided at the same time, all at the same time.

The most beneficial aspect of value-based care is that it compensates providers for doing what they should be doing, providing high-quality and low-cost treatment. Instead of only treating illness once it has already taken place, this system would motivate medical professionals to emphasize disease prevention. It would also incentivize healthcare providers to spend more time with each patient, learning about them as individuals and the specific requirements of each case.

Reimbursement Models Need to be Reformed

Our reimbursement models require significant revision for value-based care to reach its full potential. The existing system of paying for services on a fee-for-service basis rewards providers more for the quantity of care they offer than for the quality of that treatment; this needs to be changed.

The reimbursements for value-based care ought to be arranged in tiers, with more significant payments going to providers that give care of a higher quality. This would provide providers with an incentive to concentrate on providing care that is of high quality and is also cost-effective rather than simply cranking out a high volume of services.

It is high time that our reimbursement models be updated to reflect the current state of affairs. We need to modify them to incentivize providers to give value-based and high-quality care.

How can we provide better treatment while reducing the unnecessary waste we create?

The way we provide medical care needs to be improved. Compared to other wealthy countries, we have the highest healthcare spending per capita but the lowest rankings for quality and access. Our method is not only ineffective but also wasteful.

It may be possible to improve the value of healthcare by abandoning the fee-for-service model, which gives clinicians incentives based on patient volume. Instead, we need an approach to healthcare known as value-based care, which reimburses providers based on quality.

Treatment that is based on value has the potential to improve outcomes while also lowering costs. Studies have shown that patients who receive coordinated care based on teams have better overall health outcomes, experience fewer issues, and go to the emergency room and hospitals less frequently.

In Conclusion

I hope this article has given you a better understanding of value-based care and how it differs from the traditional fee-for-service model. Value-based care is a patient-centered approach that focuses on quality over quantity, and I believe it has the potential to transform healthcare for the better.

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