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  • Value-Based Care

If the health industry ever wants to maximize its patient recovery and profit-earning potential, the switch from fee-for-pay systems to value-based care needs to happen as quickly as possible. Although nearly one-third of physicians are still clinging to the old fee-for-service systems, this approach is shortsighted.

There is good news for both cancer patients and health care providers alike; the new Oncology Care Model introduced by CMS will promote value-based care from now on, rather than the old payment structures for cancer care providers, which rewarded quantity over quality. Starting July 1, 2016, over two hundred different physicians and seventeen insurance companies have been chosen to take part in the new Oncology Care Model. The model will run all the way through June 30, 2021, and health care providers participating in it will be able to assume financial risk, should they choose to do so, as soon as 2018.

Under Medicare’s voluntary bundled-payment program, system leaders at St. Luke’s University Health Network realized that they could save costs and improve post-acute care outcomes by reducing the list of post-acute care providers they use. St. Luke’s University Health Network, a very large health care system in Pennsylvania with seven different hospitals, was able to lower the number of readmissions and length of patient stays at its post-acute care facilities by improving the processes of its skilled-nursing facilities and data analyses.

The emergence of Value-based Care has left many healthcare providers split between the promises and worries of the program. It aims to improve outcomes and financial returns but poses concern about bugs and data gaps. As providers continue to move into this new care paradigm, a range of fears about its potential effectiveness have surfaced, as well as specific challenges to overcome.

When it comes to payer-provider collaboration, a few common concepts are essential to ensure smooth payer-provider collaboration. Value-based delivery models and the new emphasis on patient-centric care are integral in the move away from the traditional reimbursement fee-for-service model. Clinical measurements and metrics are major themes in payer-provider collaboration. Metrics need to be agreed on by both parties before providers and payers work together on contracts that are risk based.