Value-based care is an emerging framework that pays medical providers based on a patient’s health outcome. It differentiates itself from other popular models such as FFS by focusing on quality rather than quantity of service provided.
Traditionally, hospitals and healthcare providers use FFS, a fee-for-service model to treat their patients. The FFS model compensates healthcare providers based on the amount and quantity of service.
Payments in the FFS model are usually not bundled. Insurance companies and government agencies are billed for each visit, consultation, and hospitalization by the patient. Regardless of the outcome, this long-established model rewards doctors and physicians for the volume and quantity of service provided. In other words, FFS is not overly concerned about the result of the health intervention.
Due to these constraints, medical experts eagerly look for alternate methods to improve healthcare value.
What Is Value-Based Healthcare?
The value-based healthcare model pays hospitals and healthcare facilities according to the quality of service rendered rather than the quantity.
Accordingly, the provider is rewarded for promoting healthy patient outcomes and assisting patients in living healthier life. Proponents of value-based oncology care also allow patients and the medical community to work together to achieve their goals.
The Demand For Value In Healthcare
The demand for a value-based care model in the United States became evident as healthcare costs continued to skyrocket despite active policymaking and increased healthcare spending.
For instance, the United States has the highest suicide rates and lowest life expectancy among the high-income countries, although healthcare spending is twice as much as these nations. Similarly, research indicates that the rate of chronic disease and obesity is much more significant compared in high-income OECD countries.
As a result, medical experts started advocating alternate care methods. In 2006, Michael Porter and Elizabeth Olmsted Teisberg were credited for using value-based healthcare in the book “Redefining Health Care.”
Efforts to introduce the model proved very successful. A few years later, the Affordable Care Act provisions encouraged healthcare providers to offer services according to a value-based healthcare model, emphasizing quality over quantity.
Reimbursement for Value-Based Care
In the value-based healthcare model, providers are reimbursed based on the quality of service. Here are some of the significant quality metrics:
- Effectiveness & Efficiency: These quality measures evaluate whether the provider has taken appropriate steps that could prevent readmission.
- Timeliness: This measure addresses the right of patients to get treatment without long wait times and delayed appointments.
- Safety: Safety procedures such as preventing secondary infections and reducing extraneous complications are critical elements of value-based care.
- Patient Experience: The model emphasizes that patients should always get a thoroughly fulfilling experience. They should feel that their providers genuinely care about their well-being.
- Equitability: The equitability metric focuses on offering services to everyone, regardless of demographic. This can include understanding and addressing social determinants of health, such as the economic status of patients.
The Challenges of Implementing Value-Based Care Framework
While value-based patient care has many benefits, transitioning from a free-to-service model to a new framework is challenging. A shortage of trained staff and appropriate infrastructure is perhaps the most critical hurdle to overcome on the operational front. From a management perspective, programs can differ by the payer as each plan has its models, metrics, and documentation requirements.
Another critical challenge is selecting a healthcare reimbursement model to keep everything functional. Some healthcare providers have chosen a middle ground between FFS and value-based care models regarding reimbursement models.
Other value-based care elements that can stop healthcare providers from adapting the framework include unrealistic goals, complicated quality metrics, compliance concerns, risk of not meeting quality targets, program length, and delayed payment cycles.
Despite the challenges of implementing value-based healthcare, experts believe that the benefits of value-based care far outweigh such challenges. Increased patient satisfaction, reduced healthcare costs, and fewer medical errors are prime examples of adapting value-based care frameworks.
Community Oncology and Value-Based Care
Cancer treatment can be complex and span many years. During the time, keeping patients close to their homes, family, and friends was the defining feature of community oncology practice. Under the circumstances, community oncology offers patient-centric care by lowering the costs to patients, health plans, and community physicians.
Research also indicates that community oncology delivers better quality care than in hospital settings. It’s a homely setting where an entire team of health experts is at the disposal of the patient promoting personal attention.
Since community oncology offers affordable and local access to cancer care, more than half of patients get treatment in a community setting. In the future, community oncology will likely play a more significant role in healthcare because its goals align with the broader scheme of value-based care.
This is why most community oncologists function as the patient’s primary care physician. Once the treatment is completed, the community oncologists continue to monitor patients, often for the remainder of their lives.
About Horizon Oncology & Research Center
At Horizon Oncology & Research Center, we believe in cancer care that is patient-centric and value-based. Through our wide range of comprehensive cancer services, we provide quality, compassionate care that respects the needs of patients and our families. Contact us to learn more or schedule an appointment.