Medical Billing Services

Meaning of value-based care for providers

Change is the part of life some changes are natural, on the other hand, some grab people by surprise, like the changes which are presently tabulating up the health care industry. Previous days providers were only focused on a number of patients they cared for. Nowadays the scenario is completely different people are expecting value-based care to which the healthcare industry is responding positively. So what is the actual meaning of value-based care and its significance for providers?

It is one kind of reimbursement, which offers healthcare providers incentives depends on the quality of services they offer to patients. Primarily, this value-based care model rotates around the treatment of the patient and also on the ways providers are able to enhance their quality of care. Moreover, this model is based on specific metrics like enhancing preventive care, usage of certified health technology, and decreasing hospital readmission. The Centers for Medicare & Medicaid Services (CMS) have already introduced different value-based models over the past decade.

As the healthcare industry transforms into different ways of providing care, several healthcare providers are still curious about how value-based care is different from the traditional model, what programs are available, and how successful has it been? Now, let us understand changes between the conventional model known as free for service care and value-based care model.

Difference between value-based care and fee-for-service care

Traditionally, reimbursement was depended on the volume of service provided which termed as free for the service care model. Moreover, this model is also known as pay-for-performance. This model paid providers for their total count of patients and the volume of services they provided. As a result of this providers order more procedures and tests and handle more patients to get paid well. The key difference between these two models is that one focuses on quality and other focus on quantity.

One of the key factors in fee-for-service models, the healthcare industry was spent more on patients’ treatment whether the patient output is increasing or decreasing and also increased price differentiation for procedures and a high number of tests. Apart from this, the model challenged workflows of providers owing to the concentration of physicians towards the number of patients and every claim was processed in a fragmented network.

To lower healthcare costs and increase patient output, the federal government developed value-based care programs. Such models of reimbursement and treatment rely on improving the standard of care while increasing patient access at the point of care and paying for the price.

Advantages and disadvantages of value-based care

The value-based care model is appreciated across the healthcare industry and seems like a win-win situation for both patients and providers. Though there are numerous benefits attached to value-based care also there are some cons.

The major advantage for patients is the concentration of quality preventive care, rather than giving attention to the cost of batteries and tests. Additionally, providers also lower waste, plan their processes to become more effective and earn monetary benefits.

As far as disadvantages or challenges are concerned, there are stringent rules and regulations on providers. Implementation of programs like bundled payments, which is based on shared savings may be complex for providers. In reality, there is no other option for providers besides value-based care. As CMS is anticipated to attach all Medicare payments to value-based care models.

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