What is value-based care?
The healthcare system in the US has been changing for several years under healthcare reform. While the expansion of insurance coverage for Americans is the most obvious change under Obamacare, there are many other changes that all serve what is referred to as the “triple aim” of healthcare reform. These three components are:
- Improving the patient experience
- Improving health outcomes
- Controlling healthcare costs
It is quite well known that healthcare costs in the US have been rising at an alarming rate. The US spends more for healthcare than any other developed nation. So value-based care alters the healthcare system in ways that reward cost-effective care. There are two main ways in which this is being done. One is through cost sharing, or risk sharing, with insurance companies. For example, insurers are paying some healthcare providers a lump sum in exchange for maintaining their patient’s health. This shifts the incentives for payment away from the current fee-for-service model. In other words, providers are rewarded for keeping patients healthy instead being rewarded for doing more tests and offering more services.
The other way the system is changing is through the routine reporting of health outcomes. This requires healthcare providers to measure meaningful health outcomes in their patients. For example, in 2017 the Centers for Medicare Services (CMS) is implementing the merit-based incentive payment system for physicians. This will more directly link physician payments to patient health outcomes and quality. Other 3rd party payers will eventually follow.
So why should healthcare consumers care? For one, they will be part of these changes. Consumers will have to participate by providing information on health outcomes. More importantly, though, consumers benefit directly when healthcare is more cost effective.
At STAR, we have been measuring health outcomes for several years. We are ahead of the quality care curve. We know where our patients need to go, and we know when they get there!
Marca Spoto PT, DC, OCS