Payment models for value-based care initiatives

Moving from fee-for-service payment models to value-based care initiatives can be challenging and confusing. Our eBook tackles the topic.
value-based care

In medicine, there’s a complex balance between two competing goals. The first – providing the highest quality care – likely seems obvious. The second – managing the financials – is equally important as it supports the ability to provide patient care to begin with.

Figuring out the best way to balance these priorities is anything but easy. Indeed, Congress has spent decades attempting to legislate an optimal set of guidelines, rules, and regulations surrounding care and cost. For the modern era of healthcare, that began with the idea of fee for service (FFS). Simply put, for each service a clinician provides, a corresponding fee is reimbursed.

But this led to an overordering of services that weren’t always necessary, and placed the focus of payment on a provider’s actions, not the clinical outcomes of their patients. Too much of a focus on the money aspect, and not enough on care. The metaphorical balance was off.

So, with legislation such as the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA), a shift emerged. That shift is what we now know as value-based care (VBC). The goal? To move the balance back to center by financially rewarding providers who administer care that leads to improved patient outcomes.

Distilled down like this, the change can seem simple and straightforward. But while the reasons for moving toward a value-based care reimbursement structure are easy to comprehend on a macro level, the actual nuts and bolts of making the shift are anything but.

From an alphabet soup of acronyms for different payment models, to resource allocation, to the role of Medicare payments, understanding the ins and outs of VBC can be a challenge for even the most astute healthcare professional.

In our latest eBook, we break down some of the key things to know about the payment metrics and mechanisms behind value-based care – and take a brief look at some of the challenges that still stand in the way of widespread adoption.

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