What is value-based care?
Considering the massive cost of healthcare in the United States, both government officials and individual hospitals are always looking for opportunities to save money without harming patient care. (There are, however, ways to save money that can even improve patient care like automating your non-interfaced document workflow.) The concept of a value-based model of care is an idea that fits the bill, but as we approach two decades of the payment model’s introduction, it’s unclear how much of an impact it makes.
The concept is simple, value-based care is an alternative to fee-for-service care in an attempt to link healthcare payments to the quality of care administered. In reality, the road to value-based care is paved with the acronyms of the government programs supporting it leading to a mixed set of results. Value-based care services provider Pearl Health wrote an article about the history of value-based care that includes this helpful graphic showing some of these programs.
Source: https://pearlhealth.com/blog/healthcare-insights/history-of-value-based-care/
The common refrain, and one that I’ve already used here, is that value-based care has provided mixed results. So rather than looking at the concept in its totality, The Commonwealth Fund put together a resource that provides links to studies evaluating the impact of these Affordable Care Act programs. The Commonwealth Fund is a foundation dedicated to promoting high-performing, equitable healthcare with a focus on the most vulnerable.
Is value-based care successful?
What’s clear when looking at these results is that it’s difficult to have a noticeable impact on healthcare finances and results. So while it’s unlikely that value-based care will transform healthcare as we know it, incremental changes can make a difference at a large scale and quality of life is difficult to price. The individual programs in action at the moment may not be the solutions themselves, but there are still successes to be celebrated and things to learn from all of them. Whether it’s how targeted or broad a program is, how participants are incentivized, and how the results are measured are all important to compare in evaluating these programs, but also to consider in new ones going forward.
Broadly focused programs involving risk-sharing, savings-sharing, and outcome payments like Home Health Value-Based Purchasing (HHVBP) Model, Comprehensive Primary Care, and Comprehensive Primary Care Plus, respectively, have seemed a bit rockier than more targeted programs. At the same time, they can have a larger impact, so making them work would be ideal. Moving to CPC+ did show improvements in quality of care and use of service, but didn’t save any money. (Underserved / disadvantaged area practices were less likely to join CPC+)
There were specific successes found in other programs, although these tended to be targeted at specific subsets of the population. Independence at Home demonstrations produced good results and the greatest net savings per beneficiary of the targeted programs. Seniors aren’t the only ones seeing benefits though, as Strong Start for Mothers and Newborns, Community-based Care Transitions Program (CCTP), and Medicare Diabetes Prevention Program (MDPP) Expanded Model all showed improvements for the population segments they’re targeting.
While some programs were national and others targeted at specific populations, some even broke things down to a state level, which also produced some interesting results. In the Medicaid Incentives for Prevention of Chronic Diseases program there were very small wins for weight loss efforts, while smoking cessation seemed to have more positives, with improved quit rates and beneficial cost-effectiveness analysis. What was interesting with smoking though, was that three states have shown three different ways of evaluating cost-effectiveness:
Wisconsin – lowered cost-per-quit
California – long-term healthcare savings will be realized over a 60-year period
Texas – despite increased costs, an incentive program has net benefits because of the quality-of-life value it produces
What are the other considerations?
A problem that hospitals run into is that for new patients, or those from varying geographies, much of the information that would indicate that a patient might need a plan for health maintenance is trapped in documents that are scanned as PDFs to a patient’s record. Without some or all of the discrete data contained in these documents, clinicians are missing out on trendable data, an EHR may be missing an opportunity for alerting, and the patient profile is fractured. This means that we’ll either see duplicated effort in gathering information or missed opportunities to take advantage of a program like those outlined above.
This is where a company like Extract comes in, to automate the parts of the workflow that require too much human intervention. Inputting non-interfaced documents to your EMR or DMS using Extract’s HealthyData software is like running a race that’s already 80% complete. With key data identification, patient matching, sorting, and routing activities handled by the software, you can be sure that your data won’t be trapped in PDFs, and you won’t need a massive data entry staff to receive this valuable data.
If you’d like to learn more about a platform that can help you find those missed opportunities for better outcomes and increased revenue, please send us a message and we’ll get right back to you to schedule an introductory call or demonstration.
About the Author: Chris Mack
Chris is a Marketing Manager at Extract with experience in product development, data analysis, and both traditional and digital marketing. Chris received his bachelor’s degree in English from Bucknell University and has an MBA from the University of Notre Dame. A passionate marketer, Chris strives to make complex ideas more accessible to those around him in a compelling way.