Value-Based Care vs. Fee-for-Service: What Providers Need to Know

Doctors make money in two ways: do more stuff or keep patients healthy. Value-Based Care pays you to prevent problems. Fee-for-service pays you to fix them.

Value-Based Care (VBC) means you get paid based on results, not visits. Keep your diabetics healthy and get bonuses. Let them end up in the ER and lose money.

You make money by solving problems, not creating more appointments.

How Does Fee-for-Service Work?

Fee-for-service is simple. See patient, get paid. Order test, get paid. Make a referral, get paid. More sick patients equal more money. Healthy patients don't pay the bills.

What Are the Key Differences?

Two completely different ways to practice:

• Money: Procedures pay per visit; outcomes pay for health
• Patients: Sick care treats disease; health care prevents it
• Risk: Volume pays no matter what; outcomes bet your paycheck on results
• Teamwork: Solo docs work for procedures; teams work for populations

Why Switch to Value-Based Models?

Payers got sick of endless billing cycles. Same patients, same problems, same bills every month. They want you to fix the root cause.

Value-based care companies provide tracking systems that monitor patient health across entire populations. These platforms become essential when your paycheck depends on keeping people well.

Medicare pushes value-based contracts hard. Private insurers follow. Adapt or lose contracts.

What Goes Wrong During Transition?

Switching hurts your bottom line first:

• Upfront costs: Technology investments happen before revenue improvements
• Learning curve: Staff need training on population health management
• Risk exposure: Patient outcomes you can't control affect your income
• Data requirements: Tracking health metrics across thousands of patients

How Do You Succeed Under Value-Based Care?

Value-based care solutions integrate patient data from hospitals, labs, pharmacies, and specialists. The software identifies patients heading for expensive complications.

First, concentrate on chronic illnesses. Diabetes, kidney issues, and heart disease are the main causes of medical expenses.

Build care teams that work between visits. Nurses call patients about medications. Social workers help with transportation to appointments. Care coordinators track specialist referrals.

Key steps:

• Link all patient data sources
• Hire care coordinators and health coaches
• Track medication compliance and appointment attendance
• Intervene before problems become emergencies

What Technology Do You Need?

• Value-based care solutions monitor patient populations 24/7. The platforms flag medication gaps, missed appointments, and early warning signs of complications.
• Quality reporting becomes crucial. Miss your diabetes control targets and lose bonus payments. The software tracks these metrics automatically.
• Choose platforms your staff will actually use. Complex systems sit unused while simple ones drive results.

Takeaway

Payment models determine how you practice medicine. Fee-for-service rewards activity. Value-based care rewards health outcomes. Pick the model that matches where healthcare is heading.

Ready to get paid for keeping patients healthy instead of treating them when they're sick?

Persivia's platforms help healthcare providers transition to value-based payment models. Our solutions track population health, coordinate care teams, and optimize your performance under outcome-based contracts.

Stop chasing volume. Start chasing results.