5 Proven Methods to Get Specialist Participation in Value-Based Care

Health Insurance

 

What Is Value-Based Healthcare?

Value-based care is a healthcare model in which the payment system is based on patient treatment quality and outcome. Under this model, healthcare providers receive the reward when they successfully improve their patients' health and reduce the effects of chronic disease. Furthermore, the value-based care model is different from the traditional Fee for Service (FFS) model because it focuses more on the number of services. Moreover, providers receive payments for the services they incur, giving them an incentive to manage more patients to get high fees. Consequently, the healthcare sector was spending a high amount to treat patients without any positive outcome. Therefore, there was the introduction of the value-based care program, which stresses improving care quality.

What Are the Types of Value-Based Care Models?

Several types of Value-based models differ according to the risks of providers. 

  • Accountable Care Organizations (ACO) is an integrated network of physicians and hospitals which give high-quality care to their patients. CMS designed this program to ensure that patients receive the highest quality of healthcare. The providers receive savings if they can deliver high-quality healthcare. However, they have a financial risk because there are chances of losses. Providers may have to pay up for the losses for less value to patients. 
  • Bundled payment is another type that involves a single payment for the provision of services for the entire duration of care. Providers receive the cost for the performance of a particular procedure. However, if the costs exceed the bundled payment, the providers have to pay for the loss. Therefore, there is an element of risk in action. 
  • Patient-centered Medical Home (PCMH) is another type in which the patient is in contact with his/her chosen provider. The provider is in coordination with a team of healthcare professionals, and the provider can share EMRs of the patient among the group. Consequently, this can help to reduce redundant care and other costs. 

Benefits of Value-based Models

There are numerous benefits of using Value-based care models. Some of them include:

· Patients spend less to receive the correct care. Providers will focus on providing treatment that is less costly and more efficient.

· There is a collaboration among the providers, which creates better outcomes because all the providers work together to improve health.

· The overall healthcare spending and insurance costs reduce. Moving on, this model stresses providers to use less costly measures for treatment, which ultimately reduces healthcare spending. Since the Value-based Model lowers cost, insurance companies have to pay out less money.

Problems in Implementing Value-Based Care

· There are several problems in implementing the value-based care model. Firstly, there is a considerable element of risk in this model. Therefore, physicians are not ready to adopt this method. Physicians report that this model reduces their compensation. Secondly, there is less availability of tools for physicians to facilitate this model. The elements of this model include care coordination, financial risk, and quality metrics. It is a fact that specialists are reluctant to take financial risks.

· Moreover, the quality metrics/criteria also hold back physicians to practice this model. As a result, the physicians report that they are unclear and often too high to achieve. Therefore, it is safe to say that many specialists are still on the Fee for Service method, and they don’t want to adapt to the new model, which gives less reimbursement.

5 Ways to Involve Specialist in Value-Based Care

· Firstly, physicians face considerable numbers of performance measures. Therefore, it is essential to simplify the metrics to understand and adopt value-based care. Moreover, the metrics should be realistic, and physicians should receive training about them.

· Secondly, financial incentives should be made more attractive, and they should be meaningful. At least 20% of specialist compensation should relate to performance goals that can increase the specialist's motivation to improve cost and quality.

· Thirdly, it is essential to equip the specialist with the necessary tools like data and decision support tools and protocol measures. Moreover, improvement in IT infrastructure can increase communication between the ACOs.

· There should be a collaboration between specialists and other stakeholders. Value-based care is effective when there is participation among stakeholders.

· There should be fairness with the incentive program of the specialists. For specialists who are undertaking full-risk agreements, there should be protection for them from huge losses. Moreover, consultation from specialists should be done when designing their programs to reflect their best interests.