It is no secret that Americans spend more on healthcare than any other developed country, yet our healthcare outcomes are left wanting. Metrics such as life expectancy, infant mortality rates, and the rate of unmanaged diabetes continuously fall short in global studies.
Many healthcare experts will point to the American system being slow to adapt to a value-based care model as one primary reason for disappointing outcomes. In a value-based system, healthcare providers are paid based on the level of care they provide, rather than the number of patients they see. The value-based care model holds providers accountable for quality care through financial incentives.
Looking forward to 2024, it would benefit providers and patients greatly to begin a move to a value-based care model.
From fee-for-service to value-based care
The United States is slowly waking up to the need to adopt value-based care. However, more than half of healthcare payments to providers are still issued under a fee-for-service model, despite the model having some well-documented disadvantages. Under a fee-for-service (FFS) model, providers are reimbursed simply for seeing a patient and providing a service, regardless of outcomes or the quality of that service. What results is a system where providers are driven to perform more tests and order more procedures, regardless of whether they are necessary or whether those tests and procedures lead to better health outcomes.
Under value-based care, physicians are incentivized to provide better care, as they are reimbursed based on outcomes. Their primary objective is to give the best care possible, not seeing the maximum number of patients.
Focusing on better metrics
Under FFS models, the metrics for success are based on the quantity of services. Conversely, value-based care looks at metrics of mortality rates, hospital readmissions, recurrence of illnesses, and overall health of patients. This model leads providers to seek more preventive care for their patients, hoping to hit those value-based metrics.
Concerning economic metrics, a value-based care model has been shown to save money overall — up to 6% per patient, according to studies. Given that the United States spends more on healthcare than any other developed country, these per-patient cost savings could be significant.
Benefits of a value-based care model
The downsides of a FFS model have become clear in the United States. Our record rate of preventable deaths is just one indicator that the status quo is no longer working.
Under the value-based care model, only necessary tests and procedures are ordered, reducing wasteful spending and exorbitant cost passed on to the patient.
Value-based care systems also encourage collaborative efforts between primary providers and specialists, creating a care team working to benefit the patient’s overall health.
The healthcare system in the United States has suffered under a veil of distrust and bad metrics for some time. By moving to the accountability of a value-based healthcare system, the US can bolster its reputation and become a better example of patient-centered care.
Making the change
Some healthcare providers may hesitate to move from a fee-for-service to a value-based model because of the challenges associated with such a change. Providers must change the approach to providing care and the overall enmeshment that many medical organizations have with a fee-for-service practice.
Some providers may fear that moving to a value-based care model could have a negative impact on their bottom line. They are used to a fee-for-service model and do not want to risk lowering their income or increasing the volume of administrative work heaped upon the organization.
In addition, providers must upgrade their technology to move models in most cases. This necessary IT upgrade can lead to higher upfront costs for provider organizations. However, as discussed, value-based care models can translate to eventual overall cost savings.
Through comprehensive training on value-based care and collaboration with insurance providers and managed care organizations, providers can gradually shift to value-based care. Patients should also begin to take a more active role as the shift occurs. Value-based care is collaborative across the board, and this joint effort brings about a wealth of benefits.
The future of healthcare
Many providers and healthcare experts envision a world where value-based care becomes the dominant model. The goal should be a not-so-distant future where the United States is not languishing at the bottom of healthcare outcome metrics reports. Change can begin to happen in 2024, as many providers evaluate what has worked — and what hasn’t —- in the previous year and make shifts towards meaningful adjustments in care approaches.
The emergence of value-based care as the preferred care model moving forward points to a future of better collaboration between providers and patients. Once the model is adopted and becomes the new norm, the whole of the United States healthcare system is bound to benefit.
Dr. Christine Meyer
Dr. Christine Meyer is a healthcare professional who profoundly understands the challenges leaders face in care within value-based care (VBC). Through her experiences, she truly embodies the commitment and determination required to thrive in this changing field. Dr. Meyers' journey from struggling with VBC to achieving outcomes has positioned her as a pioneer in the industry. She has developed proven strategies to empower primary care practices, resulting in increased revenue, improved outcomes, and physician job satisfaction. With her expertise and genuine passion for advancing healthcare, Dr. Meyer is fully prepared to support primary care providers in navigating the transition to VBC efficiently and successfully.