As healthcare costs continue to rise, those picking up the tab for doctor and hospital costs are rapidly moving to value-based care payment models that require medical care providers to be measured, rated, and scored. The challenge for healthcare institutions is how to adapt their structure for a successful transition.

But to better understand how organizations can deliver value-based care, it's useful to understand what value-based care is and how it affects healthcare providers. Let's start from the beginning.

What Is Value-Based Care?

Value-based care is a type of payment model that pays doctors and hospitals for treating patients in the right place, at the right time and with just the right amount of care.

You can look at it as a financial incentive to motivate healthcare providers to meet specific performance measures related to the quality and efficiency of the process. The same way, it penalizes weaker experiences, such as medical errors.

As healthcare costs continue to rise, value-based care has been growing in popularity compared to the traditional fee-for-service method.

Value-Based Care vs. Fee-for-Service: What Changes?

The most significant difference between these two models is that in traditional fee-for-service, healthcare providers are rewarded by insurance companies and government agencies based on the volume of care delivered.

The payments are unbundled and paid separately, so the more tests and procedures they order, the more healthcare providers get paid. The problem with this method is that it encourages doctors and physicians to request tests and procedures that aren’t necessarily needed.

In opposition to fee-for-service models, in value-based care, doctors and physicians are incentivized to engage with patients to provide the right care based on the patient’s needs. They are encouraged to invest in new technology and break silos between different doctors, specialists, and surgeons by aligning their efforts with multiple providers.

Value-Based Care Model: How Does It Work?

Many healthcare organizations are redesigning their structure to support this new model. So, how does value-based care work in real life?

Well, there are several variations within this model. Here are the most common:

  • Accountable Care Organizations: ACO encourages the coordination between all doctors, hospitals, and other healthcare providers involved in the care of the patient to improve quality and eliminate bureaucratic inefficiencies. Data sharing, including clinical and claims data, is essential to success.
  • Bundled Payments: Different from fee-for-service, in the bundled payment model, even if a treatment involves multiple providers, they are collectively reimbursed instead of individually paid.
  • Patient-Centered Medical Home: PCMH encourages the practices of a personal provider that, together with a qualified medical team, provides continuous, accessible, family-centered, comprehensive, compassionate and culturally-sensitive healthcare to achieve the best outcomes. This way, the patient is taken care of by a single doctor and team.

Is Value-Based Care the Future?

According to a OECD (Organisation for Economic Cooperation and Development) report, wasteful healthcare spending is common, and that up to one-fifth of healthcare spending could be placed towards better use. The report goes on to say,

“Some patients receive repeated diagnostic tests or services, simply because the information is not shared across providers and that many patients receive overdiagnosis or overtreatment such as imaging for low back pain or headaches, cardiac imaging in low-risk patients, etc.”

The industry now recognizes the need to move towards a value-based care model to provide better patient outcomes, lower costs, and a reduction in wasteful spending.

For example, in 2018, UnitedHealthcare decreased costs through its value-based care platform and has reported better outcomes on 87% of quality measures among its accountable care organizations.

Apart from the critical benefits of driving down costs and improving patient outcomes, value-based care can provide better health and better care for patients.

How to Accelerate Value-Based Care

With the pressure on for providers to shift their treatment models from fee-for-service to value-based care, the need to have a technology solution that can help them move quickly to a patient-centric care structure is paramount.

OutSystems allows healthcare, life-sciences and pharmaceutical companies to rapidly build integrated omnichannel solutions that improve care communication, coordination and collaboration across physicians, nurses and patients. These solutions range from telehealth systems, patient portals, mobile healthcare applications and beyond. OutSystems is the leading low-code platform that is helping modernize affordable healthcare delivery by creating patient 360 view pulling in third-party unstructured data from sources such as wearables and clinical data (e.g. EHR, EMR).

If you’re eager to accelerate the delivery of value-based care, schedule a demo to see how OutSystems can give you the support you need for a successful transition and visit our OutSystems for healthcare page.