Value-Based Care

The healthcare industry is evolving right before our eyes. It’s no longer running primarily on the old fee-for-service incentive models and is making the switch to the much more efficient, value-based care model. In this new value-based care model, the emphasis is placed on quality of care and patient satisfaction. If healthcare organizations hope to thrive in this new world, they need to have a robust outcome improvement program in place.

As the healthcare industry makes the long, challenging transition from fee-for-service models to value-based care, some health care providers and organizations are naturally going to feel intimidated by the journey ahead. Value-based care, after all, offers no profit guarantees, and it requires some potentially daunting new techniques to be learned and tactics to be used.

Value-based care is the future of healthcare, and we’re all going to be affected by it in the healthcare industry, one way or another. Even those who choose to stick with their archaic fee-for-service setup will still be forced to ponder some new questions thanks to the competitive environment that is being brought about by value-based care.

With the Centers for Medicare and Medicaid Services’ (CMS) MACRA Quality Payment Program and its associated MIPS track moving into high gear, it’s no surprise that the use of a CMS-approved Qualified Registry (QR) is catching on among clinicians, providers, and health systems. A QR is a tool by which data is easily submitted to CMS for evaluation and annual bonus consideration.

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.

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.

More physicians are looking to shake things up or get out of the business altogether as new regulations and payment models are in effect. 46% are planning to accelerate their retirement, cut back on patients, or swap out their position for less involved “non-clinical roles.” That’s according to the 2016 Biennial Physician Survey, published last September by the Physicians Foundation.