Value-Based Care: Shifting Focus From Volume To Value

Healthcare payment has always rewarded doctors for doing more. They do more tests, more procedures, more visits, and ultimately get paid more. Value-Based Care pays providers for keeping patients healthy, rather than paying for procedures. When hospitals are paid for achieving good outcomes rather than simply maintaining busy schedules, patient care improves and costs decrease.

What is Value-Based Care?

Value-Based Care pays healthcare providers based on how well their patients do, not how many services they provide. A doctor who prevents heart attacks earns more than one who treats them after they happen. It’s basically a proactive approach. 

The old payment system worked like this:

• Order ten blood tests, get paid for ten tests
• Send patients to five different specialists, bill five times
• Keep someone in the hospital an extra day, make more money
• Perform surgery, receive a large payment

How Does Value-Based Care Work in Practice?

Hospitals and doctor groups sign contracts that align their payments to patient results. If patients get better care and stay healthier, providers ultimately earn extra. If quality drops, they lose their revenue.

Payment arrangements include:

• Shared savings, where providers keep half of any money they save
• Fixed payments that cover everything a patient needs for a year
• Bonuses for hitting quality targets like vaccination rates
• Penalties for issues like infections or readmissions

VBC Benefits For Patients

Patients get good care because their doctors spend more time examining and treating them rather than being concerned about their monetary gain. 

Patients see improvements like:

• Longer appointments with more personalized attention
• Better communication between their different doctors
• Doctors focus on stopping illness before it starts
• You pay less for checkups and preventive care
• Fewer errors because of better coordination

Value-Based Care Implementation

Top value-based care companies know both the medical side and the business side of healthcare. They help hospitals and doctor groups navigate new payment rules while still providing excellent patient care.

Leading value-based care companies offer:

• Software that predicts which patients will get sicker
• Systems that help coordinate care between different doctors
• Tools that track quality measures for insurance reporting
• Analytics that show whether value-based contracts are profitable

These companies understand that switching to value-based care requires new technology and new ways of working.

What Technology Do Providers Need for Value-Based Care?

Value-based care solutions need to connect patient health information with financial data. Doctors need to see both how their patients are doing and whether they're meeting their contract goals.

Key technology features:

• Alerts that identify patients at risk for complications
• Reminders about missing preventive care, like mammograms
• Cost tracking for each patient's complete treatment
• Automated reporting for insurance company requirements
• Dashboards that show population health trends

The technology should help doctors make better medical decisions while meeting business requirements.

What Challenges Do Providers Face?

Most providers struggle because their systems were built for the old payment model. Common problems include:

• Different computer systems that don't share information
• No way to track quality measures across all patients
• Staff who resist changing how they work
• Cash flow problems during the transition period
• Difficulty predicting which patients will cost more to treat

Success requires new systems, staff training, and patience during the transition.

Making Value-Based Care Work

Healthcare payment is changing, but doctors need better tools to track outcomes and manage contracts. The switch requires technology that tracks both patient health and contract performance.

Persivia offers value-based care solutions that help healthcare organizations succeed in outcome-based payment models. Our platforms connect patient data with financial performance so providers can deliver excellent care while meeting contract requirements. We help healthcare organizations focus on patient outcomes while maintaining financial health.