Value-based care is the growing alternative to the traditional fee-for-service model of healthcare as the industry seeks to move towards a more efficient healthcare delivery system. Instead of paying providers for the sheer quantity of health services provided, value-based agreements incentivize providers on the quality and/or efficiency of that care.
The Centers for Medicare & Medicaid Services (CMS) Innovation Center recently accelerated this transition by releasing a 10-year strategic roadmap that prioritizes value-based care.
“For healthcare leaders who aren’t there yet, now is the time to embrace the value-based journey and refocus efforts on putting the patient first,” said Chan Chuang, MD, director Medical and President of the Medical Group at Envision Healthcare. Below, Dr. Chuang discusses key highlights of the value-based care landscape, the critical role that clinicians will play in realizing this future, and the importance of innovative care models such as integrated care and the triage, treatment and emergency transport (model ET3).
Q: When talking about the future of healthcare, value-based care always comes up. How do you describe value-based care and what makes it so essential to the evolution of our health care system?
A: Given the current structure of our health care system, care delivery and reimbursement model, our country faces an unsustainable cost structure characterized by rising health expenditures associated with relatively poor health outcomes. The United States ranks almost last among developed countries in terms of health index and life expectancy. The push to shift to value-based care is not just about putting the patient-clinician relationship first, but about making care more accessible, affordable, and sustainable while improving patient outcomes and overall health. of our communities.
One area where we can see the value-based equation in action is the focus on appropriate sites of care. An example of this is the movement of some elective surgical cases from higher cost hospital settings to Ambulatory Surgical Centers (ASCs). ASCs have proven to be a more convenient setting for patients, a more efficient model for surgical cases, and a lower cost care environment, all while producing the same or better clinical outcomes. COVID-19 has also changed how patients and clinicians approach and embrace alternative care environments, such as virtual healthcare, urgent care clinics, and home care. Aligned with the right incentives, these models of care enable patients to receive the most appropriate care when and where they need it while achieving the triple goal of improving patient experience, improving population health, and management of our resources.
Q: What are the key advantages of value-based care over a fee-for-service model?
A: Value-based care allows us to pivot to a more sustainable model for patients and clinicians that is also grounded in scientifically proven data points that more care does not equal better care.
From a clinician’s perspective, our goal is to provide the best possible care to patients and ensure that they are prepared for success throughout their care journey. Value-based care aligns with this effort because it prioritizes reimbursement for positive clinical outcomes, enabling investment in population health-focused healthcare infrastructure. More importantly, it encourages every stakeholder in the healthcare system to be more intentional about how they support clinicians in delivering patient care.
Healthcare systems and providers that participate in a value-based alternative payment model differentiate themselves and put themselves in a stronger business and financial position to lead the healthcare industry, especially in the current environment we are in. facing significant shortages of clinicians and nurses, increasing lability and uncertainty in patient numbers, and declining fee-for-service reimbursement.
From a consumer perspective, in an ideal value-based world, patients will be able to spend more time with their physician and/or care team, be motivated to improve their health outcomes with fewer cost-sharing responsibilities. and have better experiences without rushing through the healthcare delivery system.
Want to read the full article? Here’s a preview of what you’ll find:
- How Envision integrates value-based care into its services
- Dr. Chuang’s advice for hospital leaders who are still hesitant to move to value-based care or who are ready to start but aren’t sure where to start.
- Read the full Q&A article
Chan Chuang, MD, FCCP, FACP is Chief Medical Officer and Medical Group President at Envision Healthcare
Envision Healthcare is a leading national medical group that delivers care when and where it’s needed most. They are responsible for treating more than 32 million patients each year.
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