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Value-Based Care Model

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Care that just makes sense.

The healthcare industry is constantly expanding and looking for new ways to provide better, more sensible care to its audience. With patients searching for more affordable options, and providers doing what they can to cater to their patients’ needs, the healthcare industry is undergoing significant change. And there’s a new type of care that’s becoming more popular across the country and even worldwide: introducing Value-Based Care.

What is a Value-Based Care Model?

The Value-Based Care Model is a type of healthcare model that incentivizes physicians to provide a high-quality of care rather than large amounts of it.
So, what does it mean to provide “a high quality of care”? Well, in order to measure the efficiency and effectiveness of care being provided, insurance companies use certain metrics to determine the health of their patient before and after treatments and visits. These metrics can include things like reduced hospital admissions, healthier weight percentiles, successful surgical procedures, and more.

Because of this, Value-Based Care has been touted as a “patient-centric” model of insurance with a focus on preventing disease and detecting conditions during early stages. It’s designed to both save the patient money and improve the outcomes of their overall health through a proactive approach. It’s still a fairly new idea in the healthcare industry, but the advantages it provides make it a promising option that more practices and insurance providers are growing comfortable with.

What are the Benefits of a Value-Based Care Model?

In our current world, where data is becoming increasingly more available, it makes sense to have a healthcare system that is data driven. This is where Value-Based Care exceeds other types of insurance models.

Benefits for Patients:
  • Less money spent
  • Better outcomes overall
  • Consolidated payments
  • Increased satisfaction with service
Benefits for Providers:
  • More efficient care
  • Less physician burnout
  • Consolidated paperwork
  • Coordinated, specialized care

Value-Based Care vs. Fee-For-Service Care

To put it simply, a Value-Based Care Model is based on quality of care, whereas a Fee-For-Service structure is based on quantity of care.

In a Value-Based Care Model, prices are tied to a healthier outcome for the patient, meaning providers are given incentives to improve the overall wellness of their patients. In comparison, a Fee-For-Service model operates in a way where the price of care is based on the amount of care provided.

For example, in a Fee-for-Service model, a patient’s insurance gets billed for each service that is provided. So, if a patient were admitted to a hospital for a dislocated wrist that required surgery, they’d pay for each of the following separately:

  • Anesthesia
  • The surgery itself
  • The hospital room
  • The pain medication afterwards
  • Post-operation costs (any infections or complications following the procedure)

Ultimately, each of these are standard costs required no matter what – even if the surgery was unsuccessful.
In the Value-Based model, the patient would receive one single charge for the entire surgery. The insurance company would review the patient’s recovery metrics post-procedure (continued pain afterwards, infections, readmissions), and each would be examined to determine how effective the procedure was overall. This would determine the final cost to the patient.

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