By Abhinav Shashank
Transitioning from fee-for-service to value-based care in healthcare has been one of the most important industry-wide initiatives over the past few years. And as physicians are no less than the anchors that hold the ship of healthcare in place, they would be affected greatly by the changes in healthcare, and have a great deal of impact on how care is delivered to the masses. However, according to a survey of executives and decision-makers of healthcare organizations conducted in 2016, 94% of them admitted to being on the path to value-based care, yet only 27% of them were actually on a significant stage- a slow change from the numbers in 2015.
The drawbacks of fee-for-service
As we witness, the deeply rooted fee-for-service model in healthcare, we can also point out how its predominance was mainly the reason behind the increasing cost of healthcare in the U.S. The fee-for-service model overlooks and accounts for wasteful spending; furthermore the model doesn't offer any alignment of financial incentives between different providers.
As a result of the prevalence of fee-for-service, patients often ended up receiving the care they didn't need and providers not being on the same page about what kind of care should the patient receive. Moreover, the fee-for-service model did nothing to encourage cost reduction and quality care and made population health management a far-fetched goal.
The winds of change- Transitioning from volume to value
Value-based care is still in its infancy- and perhaps that's the reason behind a slow transition. According to the physicians' willingness to adopt value-based reimbursement, they can be classified into three groups:
- Willing: If provided with appropriate incentives, these physicians are likely to participate in value-based reimbursement models, and most of them have supporting tools like EHRs, health IT, etc.
- On the verge: These physicians are a little cautious about value-based reimbursement and what changes will their practices undergo. They have less experience with VBR models, and fewer supporting tools.
- Resistant: Resistant physicians are almost completely skeptical about value-based care and unlikely to participate in these models, even with incentives.
What does value-based care mean for providers and why to step into it?
I think we can agree when I say, the advent of value-based care implies an improved focus on delivering quality care at lower costs and providers should thereby align their personal and operational objectives with the objectives of value-based care for two reasons.
First, it's about the health of the masses. It's about adding value to treatments and measuring significant differences in the outcomes. These outcomes can be of added value when used actually in subsequent visits and treatments. Providers need to have the capability to track measures and apply these results to future care and move towards an era of preventive care in a sustainable way.
Second, the rate of healthcare spending is growing and providers should be the ones extending value proposition to their patients. They should encourage necessary services whose clinical benefits are much larger than their costs and discourage repetitive tests, wasteful spending or any other service that fails to justify its cost.
The road ahead
I'll emphasis again, the shift from volume to value is the need of the hour. The way care is delivered will be heavily impacted and the quality improvement process will accelerate, but value-based care has its own set of opportunities and challenges. Figuring out strategies for success and implementing value-based care in a practice is tough and many providers lack the technical know-how of data mining and management, patient outreach, and other factors that affect quality. It's all about stepping in, finding ways, and incorporating new measures into care routines. Only when all the providers are on board with value-based care and work together, the goal of an affordable and equitable health care would be within reach.
Abhinav Shashank, Co-Founder & CEO at Innovaccer, is an expert in population health management and robust technologies. For the better part of the decade he has been working to revolutionize healthcare delivery with 25+ value-focused organization and making over 10 million lives better.