Delivering on the Promise of Value-Based Care

It’s been more than a decade since value-based care started making waves in healthcare. And from the start, there have been three core goals of the new model: creating a better patient experience, improving population health outcomes, and reducing healthcare costs.

The conventional fee-for-service (FFS) healthcare model rewards providers based on how much they do, and not necessarily how they impact outcomes — if they want their practice to succeed, they need to fit in more patients, order more tests and procedures, and so on. But the result is reactive, episodic care and soaring healthcare costs, for everyone. That system isn’t just more confusing and costly for patients, it’s also draining and frustrating for providers.

Value-based care puts patients first and incentivizes providers to do their best work rather than the most work. Since the first value-based programs were introduced following the Affordable Care Act, the healthcare industry has experienced a slow, but steady shift toward a value-based model. Now, there’s a growing consensus that it’s the future of healthcare. In fact, 87% of payers expect the percentage of value-based payments to increase in coming years.

But while most tend to agree that we’re moving toward a future where value-based care becomes the dominant model, it remains a challenge to figure out how to make that happen in a way that really works for everyone — payers, providers, and patients.

The current state of value-based care: Real successes, real skepticism

The Centers for Medicare and Medicaid Services (CMS) started with five core value-based programs, and now have more than 40 programs. Now, CMS has successfully tied 90% of payments to value, and 40% of all payments flow through alternative payment models (APMs).

Spurred by rising healthcare costs and an aging population increasingly suffering from chronic conditions, some commercial payers have started joining government payers in adopting the value-based care model. We are still early in the journey. At the same time, 97% of providers still heavily rely on compensation from FFS payments, with only 36% percent of those providers also drawing some portion of their compensation from value-based payments.3

For the early adopters, this is the opportunity they’ve been waiting for to implement creative care delivery methods so they can increase their impact. Ideally, they can prevent and help manage conditions before they become critical enough for medical intervention or hospitalization. These can include lifestyle interventions like becoming more active, eating healthier, managing stress, and more. At its best, value-based care requires a new approach and new tools that help patients live healthier lives — getting to the root of many issues and providing care before an adverse event occurs. By taking a proactive approach in a lower cost setting, healthcare providers can focus more time on the patients who need the most help. 

All that said, sometimes, there’s a mismatch between the promises of value-based care and what it delivers in real life. There are concerns from some providers and patients that patients aren’t really getting the best care under a value-based system; they’re getting care that’s overly focused on revenue and cutting costs — meaning they can’t always access the specialists they want to see or they’re discharged from the hospital before they feel ready to leave. Those are valid concerns, and there’s definitely room for improvement in how value-based care is implemented.

The future: Balancing cost-savings with patient and provider goals

The potential is there for value-based care to transform the healthcare industry. For now, it’s all about learning from current successes and challenges to truly make good on its initial promises.

The incentive for payers to adopt a value-based model is clear. When done well, value-based care can and should save them money. So the real key to value-based care’s success lies in getting patients and providers on board and equipping them with the right tools and solutions to support seamless workflow and engagement across the care journey.

Most patients don’t know what value-based care is, and they don’t necessarily need to understand the concept to reap its rewards. But if the care they receive suddenly changes, they’re going to notice — and if they’re not adequately prepared for that change or its implications, they may disengage from participating in their care. Patients want to feel included and in control of their health. If they’re less engaged, it’s much harder to improve health outcomes. 

Some providers are also apprehensive: They don’t want a change in care delivery model to impact their existing relationships with patients, and adopting value-based care can also be a financial risk for them. For smaller practitioners especially, trepidation around change management also plays a role — it takes time and resources to ensure a smooth transition. It’s easier for government payers, large insurance companies, and other deep-pocketed organizations to change. Smaller providers need reassurance that this is the right move for both their livelihood and their patients.

To help overcome these concerns, the patient-provider connection needs to be at the heart of value-based care during both the initial implementation and in everyday practice. And that’s where new tools and creative care delivery methods can provide a crucial piece of the puzzle.

Telehealth and mobile outreach exploded during the pandemic, and both are becoming an important part of connecting busy patients and providers more often and at critical moments. Patient-generated data from health apps and wearables can also play a role — providing patients with a better day-to-day understanding of where they are in their health journey and giving providers a fuller picture of how a patient is doing. These tools all foster better collaboration between patients and providers, so they can focus on improving health outcomes.

When that focus on patient satisfaction and health outcomes is balanced well with cost-saving efforts, value-based care can and will succeed.

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