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Pro and con discussions involving all aspects of value-based care vs. traditional fee-for-service roiled many as this transformation in how our country will practice healthcare percolated. For one, a national survey of providers revealed many were concerned that clear metrics have not been established for pay-for-performance practice so they would, in turn, not be fairly compensated for their performance. Uncertainty like this did not bode well for universal adoption.
Value-Based Care Does Indeed Save Costs
But since then, the tides have clearly shifted. Now there is evidence that shows value-based care is indeed measurable and is showing significant savings results. A report from the Health Care Payment Learning and Action Network, a part of the U.S. Department of Health and Human Services, showed that healthcare payments attached to value-based care soared to 34 percent in 2017, up 23 percent from 2015. This embraces an astounding 226 million Americans (80 percent) of the country’s covered population.
Another study indicates that Blue Shield of California attributes a tremendous $325 million in savings from 2010 to 2015 to its Accountable Care Organization model, one method of value-based care, and other plans have witnessed decreases in hospital costs.
In addition, McKinsey & Co. reports that early results from a multi-payer, value-based care program in the state of Ohio reveal run-rate savings of at least $250 million annually.
McKinsey also reports that across the United States, value-based care arrangements are increasing and, on average, health systems partake in a varied value-based care portfolio.
All of these figures are indeed impressive, proving that value-based healthcare is long overdue. The timing for this nationwide move couldn’t be more opportune.
CMS Launches Initiative Focusing On Prevention
Starting January 2020, CMS has launched an historic voluntary, risk-based initiative to transform primary care to a value-based system that rewards physicians who keep patients healthy and out of the hospital. Health and Human Services Secretary Alex Azar said the CMS Primary Cares Initiative for Medicare and Medicaid beneficiaries will reduce administrative burdens and empower primary care providers to spend more time caring for patients while reducing overall healthcare costs.
“This initiative will radically elevate the importance of primary care in American medicine, move towards a system where providers will be paid for outcomes rather than procedures, and free up doctors to focus on the patients in front of them, rather than the paperwork we send them,” Mr. Azar said at a press conference.
Value Metrics Firm Up
The metrics that physicians have been so concerned about? They are rapidly evolving with practices and hospitals developing concrete methodologies for putting a financial assessment on value. Many metrics revolve around prevention. For example, OrthoTennesee, a group of orthopedic clinics in East Tennessee, highlights their key metrics. The most important is readmissions followed by surgical-site infections. The third most important measurement they account for is complications, i.e., if a physician has to handle a postoperative problem that requires additional care and therefore, additional cost.
Another example is the Washington Health Alliance, a nonprofit organization in Washington State that shares data on healthcare quality and value to help providers, patients, employers and others make better decisions about healthcare. Again, prevention is key. The Alliance provides grades in areas such as the use of generic medications, ease of access to primary care, the prevalence of health screenings and diabetes care.
Even with its variations, value-based care has finally become the preeminent form of healthcare in this country. Yet the path toward success has not yet become automatic. However, there are services available to make the transition easier for providers. ScribeAmerica is one of them.
ScribeAmerica has access to patient care research culled from millions of patient encounters. ScribeAmerica Navigators are experts at engaging patients and ensuring that the right information is always collected and conveyed. They’re trained to update EHRs and bridge the gaps between and among providers, payers and patients. They also identify at-risk patients and provide ongoing population health management services. Decreased readmission rates, improved star ratings and reduced healthcare costs are just a few of the many advantages of working with ScribeAmerica.
As value-based care entrenches itself into our healthcare system nationwide, ScribeAmerica can assist providers in ensuring that they move beyond the triple aim to achieve the highly sought after Quadruple Aim–a level of health system performance that includes care team well-being as a critical component of success.