Value Based Care

What is Value Based Care?

Value Based Care is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes and their quality of care. Under this model, healthcare providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.

It contrasts with the traditional fee-for-service approach, where providers are paid based on the amount of healthcare services they deliver, regardless of the outcomes. Value Based Care aims to advance the triple aim of providing better care for individuals, improving population health management strategies, and reducing healthcare costs.

The Centers for Medicare and Medicaid Services (CMS) is committed to transitioning from the fee-for-service system that pays for volume to a value based care approach that rewards providers for the quality of care they deliver. CMS has implemented several value-based programs to drive this transformation, including:

• The Hospital Value-Based Purchasing (VBP) Program, which adjusts hospitals’ payments based on the quality of care provided to patients, focusing on how closely best clinical practices are followed
• The Medicare Shared Savings Program (MSSP), which incentivizes to reduce costs and improve the quality of care for Medicare beneficiaries by allowing them to share in the savings they achieve for the Medicare program
• The Hospital Readmissions Reduction Program (HRRP), which reduces payments to hospitals with excessive readmissions
• The Merit-based Incentive Payment System (MIPS), which adjusts Medicare payment based on evidence-based and practice-specific quality data

Why is Value Based Care important for healthcare?

Value Based Care aligns the interests of providers with the health and well-being of patients. By focusing on quality rather than quantity, it encourages healthcare systems to operate more efficiently and effectively, leading to improved patient outcomes and satisfaction.

This approach also motivates healthcare providers to focus on preventive care and the management of chronic conditions, which can significantly reduce healthcare costs over time. Value Based Care represents a shift towards a more sustainable and patient-centered healthcare system, where the ultimate goal is to achieve the highest possible standard of health and quality of life for patients.