Value-based care, put simply, is an innovative way to pay healthcare providers that is based on the quality of the care they provide instead of the quantity. In this model, providers are more accountable for delivering effective and efficient care. Doctors and hospitals are compensated based on their ability to help your employees get healthy, and stay healthy, through better coordinated care. This is different from traditional fee-for-service payment models that pay doctors based on the quantity of services they provide.
To curb rising healthcare costs, the industry has shifted to more sustainable payment models that incentivize providers to deliver high-quality care at lower costs. Value-based care compensates providers based on the quality of care they deliver versus the quantity of services they provide, driving more preventive care and a focus on wellness, which over time makes healthcare more affordable.
Value-based care goes beyond reactive care to focus on keeping your employees healthy through preventive care and helping your employees with chronic conditions better manage their health. Employees receive the right care at the right time and place resulting in more appropriate utilization, improved outcomes and a better overall healthcare experience with their doctor. Your organization benefits from lower total healthcare cost, healthier employees, higher employee satisfaction and increased employee productivity at work.
While these terms are often used interchangeably to describe value-based care, patient-centered care is best described as a result of care that is truly value-based. When doctors and hospitals provide value-based care, your employees will receive care that is more patient-centered, helping to avoid unnecessary and redundant procedures and tests all while putting the needs and best interests of the patient first. In addition to patient-centered care, “population health” and “accountable care” are also terms that are often used to describe value-based care.
Value-based care fosters collaboration and communication between doctors, hospitals and specialists to better coordinate a patient’s care, resulting in more efficient care. With a focus on primary care and more preventive measures, the goal of value-based care is to help employees get healthier faster and stay healthy longer, which can lead to lower costs over time. To find deeper savings with value-based care, you can also take advantage of benefit design that steers employees to value-based care providers. Blue Cross Blue Shield (BCBS) is seeing measurable improvements in quality and cost through value-based care. In fact, value-based care providers in the BCBS network have decreased overall cost trend by more than 35 percent since 2015 compared to non-value-based care providers.1
Through value-based care, your employees will benefit from better coordinated care, leading to improved outcomes. With a more personalized healthcare experience, patients develop a better relationship with their primary care physician and oftentimes take a more proactive role in managing their health. Click here to learn more about the effect of value-based care on employees.
Data plays a pivotal role in the success of value-based care. Sharing data and analytics that are not accessible to providers leads to more coordinated care for your employees and—by avoiding unnecessary procedures, duplicative testing and other inappropriate care—improves outcomes. With data and analytics, providers are able to identify gaps in care, proactively monitor patient health and better manage chronic conditions. Value-based care also provides patients with more access to their own health data to better engage and manage their health.
There are many ways to examine the success of value-based care. Over time, value-based care helps foster stronger relationships between your employees and their doctors, which drives better coordinated care. And because value-based care focuses on prevention and wellness, as well as better management of chronic conditions, your employees may experience fewer unnecessary treatments and fewer avoidable hospital and emergency room visits. You can expect these improvements to drive better overall employee health, lower costs for your organization and employees, improve employee productivity at work and improve employee engagement in their health. Click here to learn more about how to evaluate the success of value-based care.
BCBS companies are here to help answer any additional questions you might have. View our additional resources at SmarterBetterHealthcare.com to learn more about value-based care or to contact your local BCBS representative.
1TC Evaluation 4.0 National Aggregate Results, February 2019.