Value-based care 101: what is it and when will it be implemented?

by | Jan 23, 2023 | Blog | 0 comments

As the healthcare landscape continues to evolve, independent specialty practices, like Orthopedics, are shifting from traditional fee-for-service-based care to value-based reimbursement. Value-based payment models accounted for 38.2% of healthcare reimbursements in 2019, and 36% of physicians drew compensation from value-based payments in 2020 despite the start of the COVID-19 pandemic.

Independent specialty providers may wonder: What are value-based care contracts? How do they differ from the traditional fee-based model? And what are some barriers and solutions to implementation? Read on to find the answers.

What is value-based care?

Value-based care is an alternative to the fee-for-service reimbursement model that ties payment for care delivery to the quality of care and rewards providers for effectiveness and efficiency.

Value-based care models center on improved patient outcomes and quality of care, using specific metrics to measure performance, such as:

  • Using certified health IT
  • Reducing hospital readmissions
  • Improving post-operative care
  • Using lower-cost facilities (Surgery Center)

Value-based care is designed to hold providers accountable for reducing healthcare costs, providing better care for individuals, and improving population health management strategies. Specialty practices may not realize that their practice operations will also need to shift to be successful under value-based care contracts.

How value-based care differs from traditional reimbursement arrangements

The traditional reimbursement models pay providers retroactively for services delivered, based on their contract with each payer. A practice’s overall revenue is contingent on how many services a provider completes, assuming those services are deemed appropriate and necessary by the payer. This model often requires a business strategy that depends on increasing the number of services and office visits results.

On the other hand, value-based care focuses on reducing healthcare costs and improving the quality of care by rewarding providers for patient outcomes.  Providers must operate their practices in a way that records and reports on critical indicators because total revenue depends on outcome data rather than the number of treatments. Data includes tracking:

  • Readmissions
  • Patient engagement
  • Adverse events

Value-based care contracts that hold providers accountable for quality and cost control will become more common.

Making value-based care a reality for practices today

Though value-based care is a newly emerging reimbursement method, it will continue to grow. Practices that take steps to prepare their office processes today can stand out among their competitors. Transitioning practice operations now will allow independent specialty practices to grow and flourish as the healthcare market becomes ever more competitive.

Changing reimbursement models can be complicated, but it does not have to add more work to your already-full plate. TRIARQ Health can provide the technology, financial tools, and expertise to help you provide better quality care, improve patient relationships, optimize workflow, and maximize growth opportunities. Ready to get started? Request a meeting with one of our experts today.