Value-based care has emerged as an alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity.
Value-based care is a form of reimbursement directly linking payments for care delivery to the quality of care provided: rewarding providers for both efficiency and effectiveness. Emerged as an alternative and potential replacement for fee-for-service reimbursement: the tradtional payment method retrospectively reimbursed for services delivered based on bill charges or annual fee schedules.
In order to transform how healthcare providers are reimbursed for services rendered, the Centers for Medicare & Medicaid Services (CMS) has itself introduced an array of value-based care models, such as the Medicare Shared Savings Program and Pioneer Accountable Care Organization (ACO) Model. Private payers have in turn adopted similar models of accountable, value-based care.
Traditional fee-for-service reimbursement model promoted quantity of services, while federal officials have proposed several reimbursement programs rewarding healthcare providers for the quality of care given to patients. Value-based care aims to advance the triple aim of providing better care for individuals, improving population health management strategies, and reducing healthcare costs.
Value-based care models center on patient outcomes and how well healthcare providers can improve quality of care based on specific measures: reducing hospital readmissions, using certified health IT, and improving preventative care.
As the healthcare industry transitions to this new way of delivering care, many healthcare providers are left wondering how value-based care is different than the traditional model, what programs are available, and how successful has it been?