Shift from Volume-Based Care to Value-Based Care

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Change applies to many aspects of every life. Some of those changes are obvious, but some catch people by surprise, such as the changes that are currently shaking up the health care industry. There was a time when all that mattered to health care providers was the number of patients that they cared for, but this is now changing. People are demanding value-based care, and the industry has been slowly responding to this demand.

To learn more about value-based healthcare, checkout the infographic below created by the University of Illinois at Chicago Masters in Health Informatics program.

What is the Difference Between Value-Based & Volume-Based Care?

Volume-based care refers to the payment a health care provider receives for services a patient might need. The type of service and quality of service does not really make a difference in the amount a provider might receive. This is volume-based care in a nutshell, which is sometimes referred to as a fee-for-service care.

All incentives were driving health care providers to worry about the number of patients cared for rather than the value provided. Those who measured success rate were primarily focused on profits when compared to the cost of each service. This placed an added focus on speed, which might cause some health care providers to speed through patients.

Value-based care is sometimes known as accountable care. This type of system focuses on getting value from quality services. Payments are based on this specialized care and other things, such as cost reduction, which could lead to an emphasis on preventative care.

The Four Types of Value-Based Care

There are differences between one type of care and the other. Value-based care can be broken up into four types that can be applied by a health care provider in ways that work best for the overall practice.

1) All Departments Share the Risk

One type of care involves all departments sharing the risk. They should work toward keeping spending at or below the budget. This should help keep costs down when providing quality care, which can be time-consuming.

2) Offer Contact to Patients

Another type offers a particular contract to patients. Long-term and short-term patients are asked to share costs amongst each other. The contract is based on the per person, per month model that is sometimes referred to as PP/PM. This concept has been around for ages, but it is sometimes overlooked in the health care industry. This model helps defer some of the costs and should ensure that every patient receives quality care without putting the practice under financial strain.

3) Bundle Service Offerings

Bundling is an effective tool that should help health care providers cut costs. The idea boils down to cutting certain services that are usually provided in the bundle presented to patients. Patients can choose what is important to them and what services they do not need. This allows the patient to personalize his or her care, and it allows the health care provider to save money.

4) Shared Savings

Shared savings is a way to approach value-based care by sharing the load with all departments or the entire organization. The money saved in one branch can cover the costs of others. It is a good way to help the organization reach budget goals while still focusing on value-based care without too much financial strain.

Obstacles Facing the Switch
Transitions are never easy, and this one is no different. Making the switch from volume-based care to value-based care may present a few challenges.

For one, data will be of the utmost importance, including patient satisfaction. One of the challenges that some may face is making sure there is a good amount value-based active contracts at any given time.

The only one way do this is to make sure that patients feel like the services provided meet or exceed their expectations. This can be done by performing surveys from time to time, but it is best done in person. Value-based care does give health care providers more time to talk and ask each patient how he or she feels about the care being provided. Understanding the answers, rectifying the most common complains, and sticking to what is most satisfactory should help ensure that the contracts acquired stay active.

Some health providers have a hard time understanding a patient’s needs. It is important to develop a survey to understand the overall needs of a patient to develop effective bundled services.

This transition will not be an easy road, but knowing some of the common obstacles should help an organization feel prepared to undertake this particular change. It should be noted that value-based care is a fairly new notion and will continue to evolve as time moves on. Health care providers should be ready to make tweaks whenever necessary should another issue arise that might not have been expected.

The Future of Care

This new care model is bound to affect the way that the entire industry is ran. For example, organizations may begin to offer joint savings plans to smaller health care providers should they focus on value-based care.

Health care providers may also have a little more leverage when they are dealing with big pharmaceutical companies. Some of these companies may agree to pay portions of the readmission fee. This could apply to companies that manufacture things like cardiac devices, which could indeed fail and force a patient to return to the hospital. The health care provider may not need to worry too much about carrying all the costs if better deals can be made with the pharmaceutical companies.

It should also be noted that many health care insurance companies are allocating much of their revenue toward value-based care. This means that switching to this type of care can give some health care providers a head start. This is important, especially now since patients have more and more care options than ever before.

Undoubtedly, the industry from the bottom to the top needs to change. People are demanding quality and are becoming increasingly aware of their health. Thanks to things like the internet, self-diagnosis, natural care and other types of alternative care are increasing. This means that health care providers need to change their approaches should they want to remain competitive in today’s market.


Recommended Readings

University of Illinois at Chicago Blog, “Becoming a Pharmacist in Informatics”University of Illinois at Chicago Blog, “Big Data and Wearable Health Monitors: Harnessing the Benefits and Overcoming Challenges”
University of Illinois at Chicago Blog, “Data Analytics and Informatics in Health Care: 5 Tools Professionals Should Know”