What is Value-Based Healthcare? A Complete Guide

Equip your team with the knowledge to best assess, treat, and document care. We’ll be at Booth B, eager to chat with you about the latest challenges and resources shaping value-based care. Customer Insights Team → We help bridge the gap from data retrieval to implementation for efficiency and care. Big data technology for high availability data ingestion, computation and storage. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.

The five character codes included in the Aetna Clinical Policy Bulletins are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association . CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Aetna Dental Clinical Policy Bulletins are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members.

Medical clinical policy bulletins

Value-based care—also sometimes referred to as “pay-for-performance”—is a reimbursement model that rewards hospitals, physicians, and other healthcare providers with payment incentives based on the quality of care that they provide to patients. By rewarding providers based on their care quality and clinical performance, value-based care models help to improve patient outcomes and lower overall healthcare costs. Value-Based Care is a health care delivery model under which providers — hospitals, labs, doctors, nurses and others — are paid based on the health outcomes of their patients and the quality of services rendered. Under some value-based contracts, providers share in financial risk with health insurance companies.

• Value-based care’s emphasis on quality over quantity enables physicians to take on smaller patient loads, which significantly reduces their administrative burden.
• Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates .
• Gore medical products are designed to be the highest quality in their class and revolutionary in their effect.
• An important step to implementing value-based care is to ensure you have the systems and technology in place to support it.
• And we go beyond the submission, mining the data to help you make the greatest impact on patient care every day.
• Ensure that your practice stays compliant with ever-shifting regulatory reporting requirements.

There are many benefits to value-based payment models, including improved patient satisfaction, a reduction in healthcare delivery costs, and improved health of the patient populations being cared for. With value-based models becoming increasingly popular, this drives the need for more collaboration and coordinated care between hospitals, physician clinics, health plans, post-acute providers, and other players in the care continuum. Experts agree that these longstanding, widespread problems stem in part from the misaligned incentives built into the nation’s traditional, fee-for-service payment model. Under fee-for-service, health care providers like physicians and hospitals are paid for each service they provide.

“Finding the right medicine for the right patient requires real-world evidence and expert interpretation.”

We’ll identify top priorities for compliance, high-risk patients, and process improvements so you can get to value quicker. It requires a deep understanding of quality metrics, HCC risk scores, cost and utilization of care in your population, value based definition patient engagement and outreach strategies, and more. To top it off, staff and resources must align on mutual goals in fee-for-value. We know that health care is consistently identified as a top concern for all Americans.

Replace or supplement more costly in-person visits for your low- to medium-risk patients with our effective, user-friendly telehealth tool. Of users indicated MedBridge’s exercises helped them to improve patient outcomes. MedBridge gives you the expert, data-driven capabilities you need to boost outcomes, reduce costs, and thrive under value-based care. Create a connected ecosystem across primary, secondary, and tertiary care to improve health outcomes. Successful organizations under value-based contracts typically see increased revenues and better care outcomes.

Payers + Payviders

Historically, too great an emphasis was placed on how many services a healthcare provider delivered versus the focus on the quality of care being delivered. With the FFS model, clinicians are paid for each service individually. Therefore, healthcare providers are, in effect, incentivized to provide a greater number of services per patient.

And with more time to dedicate to holistic care, the risk of medical errors is substantially reduced. Former Pulse8 solutions are now part of the Veradigm Payer Analytics portfolio. Pay for performance models offer incentives, based on https://globalcloudteam.com/ performance and quality metrics, above the traditional fee for service schedule. Some of the most important quality metrics for value-based care include effectiveness and efficiency, timeliness, safety, patient focus, and equitability.

What is the difference between value-based care and fee-for-service?

Publicizing how well health care providers and health plans perform on certain measures can drive them to improve performance. For example, people can search Medicare.gov to find out the rate of complications for hip and knee replacement surgeries at a hospital. Or, if they are looking to enroll in a particular Medicare Advantage plan, they may search the site to find out how members rate the plan.

Learn how Cerner helps organizations like yours accelerate your value-based care efforts, while still supporting your current fee-for-service business. Navigate regulatory changes, together, through education, guidance and support on regulatory requirement updates and best practices. Find and share knowledge, exchange ideas, and collaborate with peers and Change Healthcare experts to drive your solutions to success. A member of our team will contact you to better understand your needs and discuss potential solutions. Lightbeam has worked to help FCHP’s staff build workflows and standardize reporting for its care management program. April 26th 2021 Article Our experience shows how key features of value-based care can position practices to be more resilient, adaptable, and future-oriented.

Value-based care services plant roots in the evolving healthcare landscape

Accountable Care Organizations that participated in the Medicare Shared Savings Program generated $61 million in total savings for Medicare and achieved an average quality score of 98.2%—using NextGen Healthcare solutions for value-based care. Let’s partner to make healthcare better for you, your practice, and your community. Browse through our library of videos, blogs, webinars, articles and more for valuable news, information and resources for healthcare practices of all types. NextGen Healthcare continues to revolutionize the healthcare industry.