Value-Based Care: Quality over Quantity

Value-Based Care: Quality over Quantity

YES HIM Education

Value-based care is a method of reimbursement that links payments to the quality care provided and rewards the efficiency and effectiveness of providers. This reimbursement form has proven to be a possible alternative fee-for-service repayment model, which retrospectively pays providers for services delivered on the basis of billing or annual service fees. The Medicare & Medicaid Services Centers have introduced a range of valuable care options, such as the Medicare shared saving program and the pioneer accountable care organization models, in order to transform the way healthcare suppliers are reimbursed for services rendered. As a result, private payers have adopted similar accountable, value-based treatment models.

In short, value- based care models focus on the patient's results and the ways in which healthcare providers improve the quality of care using specific measures, such as hospital readmissions reduction and the use of certified IT services. As the ever-transforming healthcare industry takes its next step into pioneering new ways of delivering care, providers are left with one question; how is value-based care different from the traditional model and what are its advantages?

Value Based Care

Using the traditional (fee-for-service) model of reimbursement, healthcare providers are paid based upon the amount of services they administer. Because of this, trends show for more procedures to be performed and a higher number of tests to be ordered, increasing overall health care costs while not necessarily improving health care quality. In response to this, the federal government designed value-based care programs to drive down healthcare costs and potentially improve patient outcomes. 

The new, value-based models encourage providers to use evidence-based medicine, engage patients, utilize health IT as well as data analytics in order to get paid for their services (, 2016).

Types of Value Based Care

For many healthcare providers, value-based care is still a fairly new concept. As with any new process, it goes without saying that it will take some time to become fully understood, accepted and incorporated into the day-to-day workflow. But, with the huge potential to continue to decrease spending and improve quality of care, value-based care is definitely a method that isn’t going anywhere but up in the near future.

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