Value-Based Care: Benefits and Challenges in the Current Healthcare System

The United States is a world leader in many categories. For instance, America spends more than any country on medical research and development and is at the forefront of developing automation and artificial intelligence technology.

However, we also have the most expensive healthcare system in the world. Just last year, the U.S. spent $10,586 on healthcare per capita, about twice that of other wealthy countries. It’s not due to more utilization of healthcare services, though. An article in Health Affairs noted that researchers found the higher spending is due primarily to higher prices for medications, healthcare professionals, administration costs and more.

A key effort to address this soaring spending is through the transition from fee-for-service to value-based care. Instead of providers being paid by how many healthcare services they deliver, value-based care focuses on the quality of care. The goal is to enhance both financial and clinical performance through incentives for providers. These incentives are given to providers who meet specific quality and performance measures. 

Value-based Care in Action

The shift to value-based care is possible in part because of the influx of data from electronic health record (EHR) systems. It’s also achievable due to the emergence of multiple technology tools.

Providers can use advanced analytics to better measure and improve outcomes and augment care coordination. This detailed data also can be utilized to improve overall provider performance and reduce risks. Providers can more accurately calculate exact costs for different services they provide and obtain greater access to patient information for enhanced clinical decision-making.

Promoting interoperability in healthcare is another example of value-based care in action. By connecting and integrating disparate healthcare IT systems, providers can communicate and collaborate more quickly and easily with other clinicians, resulting in more focus on evidence-based medicine and a reduction in duplicate tests and procedures. Benefits like this play a big role in reducing healthcare costs. 

Reported Obstacles

Even though the shift to value-based care has produced some advantages for the healthcare industry, there are still challenges. For example, a study by Quest Diagnostics showed differing opinions from physicians and executives of health plans about what components are necessary to properly deliver value-based care. According to the executives, the alignment between health plans and providers has made headway. Only 47 percent of the physicians were on the same page. Also included in the study was the fact that over half of the health plan executives said they believe doctors have the tools to be successful in value-based care, but a mere 43 percent of the physicians polled agreed.

According to the study, the top four solutions to overcoming barriers to value-based care include yielding better data from EHRs, better aligning managed care executives with physicians, developing quality metrics and co-investing in health information technology. Those who listed obstacles to putting these solutions in place said it was due to lack of staff time, unpredictability of revenue stream and a lack of resources to report, validate and utilize data. 

A Proven Edge

Though transitioning to any new system in healthcare can be frustrating for both providers and patients, there are numerous benefits of value-based care. Some of these include:

• Better disease management
• Improve the health of patients with chronic conditions
• Reduced hospital admissions
• Enhanced patient involvement in care
• Sharper focus on the clinical need for procedures
• Reduced reimbursement for adverse events
• Enhanced focus on population health

Smart Solutions

Through value-based care, providers can give feedback on technology like patient portals and promote shared decision-making with patients on end-of-life care and treatments which might be risky. This stimulates engagement between providers and patients and is where utilization reviews conducted by doctors and nurses can offer sizeable assistance. These reviews help numerous stakeholders target the optimal and most cost-effective treatments to ensure each patient gets the level of quality care he or she needs.

As we’ve previously discussed, the effort to reduce cost while at the same time improving quality of care is an ongoing process in this country. As the transition to value-based care continues to evolve, we at Advanced Medical Reviews (AMR) commit to adapting our operations and compliance measures to continue to deliver quality assurance. We believe every patient should receive quality healthcare, no matter what changes in the healthcare industry.

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