Value-Based Care in B2B Healthcare Today

The National Institute of Health (NIH) recently conducted a survey that revealed that 52.4 out of 1000 people per year in the United States suffer from persistent chronic pain. Unfortunately, the cost of treatment for chronic joint pain can be pretty high. If the solution is medicinal, the cost of over-the-counter or prescription painkillers may seem small, but given that these treatments do not address the source of the pain — merely masking its symptoms — patients can expect to be paying these costs for much of the rest of their life, which adds up. If the pain becomes severe enough to require a more drastic treatment, such as surgical intervention, the cost becomes even more expensive. For example, a total knee replacement costs around $20,000 before insurance.

That being said, the costs of treatment don’t stop with the treatment itself. With total knee replacement surgery, for instance, the recovery period can last for weeks or months. Depending on a patient’s job and the amount of strenuous activity it entails, patients may have to miss anywhere from four weeks to three months or more of work. This undoubtedly adds further expenses to the cost of their care.

The high cost of care and risk of complications in pain management treatment causes many people to put off or entirely avoid seeing a doctor. But what if there was a better way for the healthcare system to operate? One that offered the care patients needed and allowed them to get better solutions with lower costs and less risk.

This is where value-based care (VBC) comes into play. Value-based care is an innovative healthcare delivery model focused on the quality of care and the patient experience. In a VBC model, the provider’s goal is to achieve the best possible care outcome for the patient because their success is determined, first and foremost, by the patient’s health outcomes.

The benefits of value-based healthcare

When healthcare providers transition to a VBC model, every stakeholder in the system sees substantial benefits. In the long run, payors save on healthcare utilization costs; providers can cut down on costs and increase their bottom line thanks to an increased emphasis on preventative care; and, of course, patients get the results they need to live a healthy, pain-free life.

One key benefit of a VBC model is that it encourages doctors to prescribe and pursue alternative treatment options that may offer patients advantages, including reduced recovery time and lower costs. In a pay-per-service healthcare delivery model, expensive procedures with long recovery times are incentivized because they are quite costly in themselves, not to mention the additional income doctors get from post-op follow-up care. However, when the outcome is prioritized over the services rendered, this opens the door to a plethora of other non-invasive treatment options.

According to the American College of Healthcare Executives, VBC “advances quality and equity in healthcare” and “accelerates innovation in care delivery.” Because VBC models often eliminate the need for surgical solutions, patients with moderate-to-severe chronic pain can receive non-invasive treatment earlier in their care journeys, leading to less pain, better mobility, and an overall improvement in their quality of life.

Furthermore, payors adopting VBC models save on surgical costs because they can promote more clinically appropriate and cost-effective alternatives. Similarly, healthcare employers who adopt VBC models often experience fewer employees taking sick days because they are more empowered to deliver better, more efficient care, and patients can celebrate more positive outcomes from getting the early and personalized treatments they need.

To this extent, VBC models also thrive when combined with additional solutions such as advanced wearable health-tracking devices and targeted physical therapy programs. These solutions play a critical role in VBC by reducing healthcare costs while simultaneously improving the recovery options available to patients.

How VBC encourages prescribers to pursue better treatment options for patients 

For one, value-based care is typically associated with cost savings for the patient. According to research from McKinsey and Company, VBC models can reduce healthcare spending for patients by as much as 3 to 20%. Since the average healthcare spending per person in 2023 is $14,570 per person, that amounts to savings of hundreds or even thousands of dollars. And that doesn’t even consider the potential of not losing as much income to missed work for recovery time.

On top of that, value-based care prioritizes providing patients with treatments and solutions that are more convenient for their lifestyles. At-home treatments that doctors may shy away from in fee-for-service models because they produce less income for them become a more feasible option in VBC models. This means patients can regain control of their pain management, giving up less time at the doctor’s office, physical therapist visits, and trips to the pharmacy. 

Moreover, VBC models tend to offer patients a better quality of life. By definition, value-based care is more transparent and equitable, allowing patients to play a more active role in their healthcare decisions. When it comes to pain management, many of the solutions commonly prescribed in pay-for-service healthcare delivery models carry the risk of complications. In a VBC model, complications would interfere with the principle of the “best possible outcome,” which encourages medical providers to pursue other treatment options that carry less risk.

Although value-based care is a radical departure from the model that many in the healthcare system may be used to, this approach to healthcare delivery offers immense benefits for patients, providers, and payors alike. Especially in cases like chronic pain management, in which pay-for-service models prioritize costly, invasive procedures like surgery, a pivot to value-based care can result in much better patient outcomes.

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