Value-based healthcare places emphasis on quality over quantity. In this model, providers aim to deliver patient-centered care, with financial incentives based on health outcomes, not the number of services delivered. Payers take overall cost, quality of care, and equity into account. The ultimate goal is to improve health at a population level by helping individuals lead healthier lives.
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Value-Based Healthcare: A Shift From the Traditional Model
Traditional healthcare uses a fee-for-service model, meaning providers get paid based on the number of services they provide. The United States spends significantly more of its gross domestic product on healthcare than other countries. Even so, the U.S. ranks last in access to care, equity, healthcare outcomes, and administrative efficiency.
Traditional healthcare faces a few significant challenges, such as:
- Quantity over quality: Healthcare organizations receive financial incentives to perform more services. This encourages providers to increase the number of patients rather than taking ownership of each individual’s health outcome.
- Potential for over-treatment: Doctors might order redundant tests or treatments instead of coordinating care between a team of healthcare workers.
- Reactive rather than proactive care: The traditional system does not emphasize preventative care or holistic approaches to healthcare, such as counseling or nutrition coaching.
Value-based care aims to improve upon these issues and deliver a better patient and provider experience.
The Benefits of Value-Based Healthcare
In addition to enhancing each individual’s experience, value-based healthcare providers look to improve health on a population level. They accomplish this in a few ways.
Personalized Treatments
A “one size fits all” approach does not work in healthcare. Value-based care prioritizes a patient’s needs, taking a holistic look at their values, priorities, lifestyle, medical history, and demographic information.
People of color and low-income individuals often face lower access to care, leading to adverse but preventable outcomes. A central tenant of value-based care, however, is improving equity.
Enhanced Doctor-Patient Relationship
In an ideal system, doctors and patients work as partners toward a desired outcome. Patients can speak up about their individual needs, while providers take ownership of their results. Generalists may be inclined to take more time with their patients, developing a personalized treatment plan, rather than reflexively submitting a specialist referral.
The relationship between patients and providers is crucial. People who trust their doctors may be more motivated to stick to their treatment plan and return for follow-ups. When patients feel heard instead of rushed through their appointments, they experience more satisfaction with their level of care.
Proactive and Preventive Care
Value-based care encompasses a comprehensive approach to health. Groups employ different kinds of healthcare workers, such as medical assistants and community health workers, making it easier for patients to access preventative care.
Value-based groups may even cover holistic services that keep people healthier in the long run, such as:
- Counseling
- Transportation
- Gym memberships
- Nutrition guidance
As one example, increased access to care can improve population health by decreasing the incidence of chronic conditions. Some healthcare organizations even use population screening technology to identify at-risk individuals based on their demographic or lifestyle information. Early detection allows providers to develop an individual treatment plan, limiting the effect of the condition or preventing it altogether.
Transparency
Patients experience more transparency in their treatment and total cost with value-based care. Since doctors get paid for quality over quantity, patients can trust that they will not be subjected to excessive exams, unnecessary services, or surprise bills. This leads to increased trust, encouraging patients to work with their healthcare team to find the proper treatment and see it through.
While price transparency for medical services still poses a challenge, a value-based approach might help alleviate some anxiety for people seeking care. These systems emphasize total cost of care rather than charging for the number of exams and services.
Coordinated Care
Value-based healthcare stresses a team approach to a patient’s health, integrating primary, specialty, and acute care. Providers can spend more time on actual treatment by reducing administrative hurdles within their network.
In part, the system ensures a smooth flow of information by utilizing electronic medical records (EMRs). Providers see real-time updates on the individual’s treatment, and the patient enjoys a seamless experience. This helps reduce redundancy in care, which in turn lowers overall costs.
In some coordinated care models, each member of an individual’s care team gets rewarded for providing high-quality services. This motivates each provider to focus on the patient’s needs and, as a team, take responsibility for their health outcomes. A fee-for-service model, in comparison, incentivizes providers to see as many patients as possible, regardless of their outcomes.
The Role of Technology in Value-Based Care
To perform effective coordinated care, value-based providers rely on innovative technology. Some of these technologies include the following:
- Electronic medical records: As discussed, EMRs allow physicians to view and update a patient’s medical history immediately. Even when the patient visits a new doctor, that provider can quickly review the individual’s medications, treatments, and test results, enabling them to make informed decisions.
- Telemedicine: Individuals can speak with a medical professional from home using their computer or phone. Telemedicine doctors might perform virtual urgent care services, write prescriptions, or provide counseling. This equalizes access to care while reducing overall healthcare costs.
- Wearable health devices: These devices, such as smartwatches, enable patients to track their personal health data. They can use this information to advocate for themselves and help their physician develop a care plan. Doctors may even use wearable devices to monitor a patient and identify complications remotely.
The Challenges of Value-Based Care
Despite its many benefits, value-based care faces some drawbacks. A significant factor is time; transitioning the U.S. healthcare system to a coordinated, preventative approach is not a simple task. Healthcare organizations may see short-term financial hits as their incentives change.
The success of a value-based group depends on its priorities, too. If the payer is too focused on lowering healthcare costs, they might incentivize reducing expensive hospital stays, for example, even if that would be in the patient’s best interest.
The group could make it difficult for patients to see costly specialists or physicians and instead direct them to lower-cost medical professionals, such as community health specialists. While a team-based approach offers many positives, it can also limit a patient’s options within that narrow network.
Embracing a Patient-Centric Future
Moving to a value-based healthcare system will take a concerted effort from healthcare organizations, medical professionals, insurance companies, and government groups. But it’s a noble endeavor, and adopting a patient-focused approach can pay off in the long run — both from a financial and social perspective.
Doctors and patients both enjoy increased trust, improved care coordination, and positive outcomes thanks to preventative services. In time, a value-based approach can improve the population’s overall health.