What Value-based Care Models Are Available?
Value-based care comes in a variety of types, generally differing by the risks assumed by providers and sharing of savings or losses.
Accountable care organizations
An accountable care organization (ACO), a network of physicians, hospitals, and other providers giving coordinated, high quality care to Medicare beneficiaries, is designed to help ensure patients receive the most appropriate care at the right time, aiming to prevent unnecessary and redundant services while reducing medical errors.
Participation is volunteer into multiple programs: Medicare Shared Savings Program, Advance Payment ACO Model, or the Pioneer ACO Model. Under the payment model, the provider network shares in the savings when the ACO delivers high-quality care and reduce healthcare costs.
Joining assumes some financial risk, with the significant potential savings, depending on the specific agreement. With shared losses, comes an obligation to repay Medicare for shortfalls in value-based care to patients.
Bundled payment, or episode-based single service payment allocated for an entire care episode, is a collectively reimbursment for the expected costs treating a specific condition based on historic prices for: several physicians, care settings, and procedures.
Relying on a specified risk level, bundle payment allows rewarding for diminished service costs below the bundled payment price by pocketing the savings. Conversingly, the provider bears the financial loss.
This arrangement allows ample opportunities to re-tool in acute care and mix of post-acute care settings, envisioning materially improved patient care with concomitant cost lowering, ultimately leading to standardized discharge practices and post-hospitalization protocols for various services: medical, rehabilitation, and other post-acute care.
Patient-centered medical homes
The patient-centered medical home (PCMH), a care delivery model focusing on coordinating patient care through a primary care physician, envisions delivering a centralized care setting managing the different patient needs.
The PCMH certification indicates that providers deliver patient-centered care, team-based methods, population health management, personal care management, care coordination, and consistent quality care. Patients in a PCMH can except to develop personal, one-on-one relationships with their care providers, who determine healthcare needs based on medical and environmental factors.