Value Based Care vs. Traditional Healthcare Delivery Models

A new wave in healthcare is here and many providers are feeling the pressure. This revolution in healthcare centers on a new model for providers and the emphasis on treatment quality over quantity. 

According to Weave’s Healthcare Business Insights Report, cost and affordability remain major factors influencing whether patients pursue care. Click here to read more about this in Weave’s Healthcare Business Insights Report.

Based on these findings, it’s clear that cost and affordability are huge factors for patients when it comes to pursuing care. The standard model for provider reimbursement is usually a fee-for-service model that centers on the number/quantity of services rather than the quality or outcome of the treatment. 

What is Value-Based Healthcare

Value-based care is a framework for restructuring healthcare systems with the overarching goal of providing long-term value to patients. This approach would ensure providers are treating patients for long-term success rather than an individual episode and revenue would rely heavily on treatment quality.

As a whole, value-based healthcare is cheaper in the long run because providers are administering preventative care that keeps patients healthy. However, there are pros and cons to each of these healthcare models that either benefit or penalize patients or providers. A value-based healthcare model will require healthcare providers to deliver long-term and high-quality care if they want to attract more patients, generate revenue, and continue to grow.

Benefits of Value-Based Care

Patients

One of the greatest benefits of value-based care is that patients will get quality treatment for their healthcare concerns. If a patient needs to see a provider while they are on vacation, they can know that no matter which provider they visit, they will be getting quality treatment. 

This is a huge benefit to patients because they would no longer have to worry about finding the best treatment or switching providers. Patients would also develop a greater trust in their provider, knowing they are delivering the best care possible for long-term success.

Additionally, the healthier the general population is, the fewer health claims will be filed—saving patients more money and reducing the risk of significant financial loss. Over time, healthier patient populations can reduce individual premiums and copays, lowering the cost of healthcare for themselves as a whole.

Providers

Although providers take on more risk in a value-based care model, this holistic approach would strengthen patient-provider relationships and increase patient satisfaction. High-quality care would mean better patient reviews and more positive word of mouth and could significantly improve the overall success of a healthcare practice. For additional information on how Weave can help you generate more positive patient reviews, click here.

If a practice is increasing the number of healthy patients, they can reduce spending on treating chronic illness management, and funds can be used in other areas. These cost savings could be put towards patient engagement software tools that help improve workflows and increase efficiency. Rather than struggle to keep up with demanding workflows and repeat health issues, providers can spend more time focusing on improving their practice and administering preventative care.

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Suppliers

All healthcare practices have suppliers who provide them with the medical products they need. Large healthcare organizations might utilize pharmaceutical sales reps to reach more customers and generate more revenue. To make sales, sales reps and suppliers need to demonstrate the value of medicines/treatments to providers and their patients. 

With a value-based model, sales reps and suppliers can target hospitals and health systems based on diagnoses, procedures, and value-based care performance. Sales reps and suppliers can be reimbursed at a higher rate when value-based care is supported. 

Downsides of Value-Based Care

Increased patient load

A downside to value-based care is the increase in patient load and demands for physicians. If a patient is unable to recover, a value-based care model would require providers to continue treating them until they are set up for long-term success. This downside could prevent practices from treating new patients and booking more appointments. With accurate treatment and diagnosis, this downside could be mitigated; however, the best treatment plan isn’t always obvious at first glance. 

Providers penalized

Providers take on more of a risk with value-based care because they are penalized when their patients don’t achieve long-term success. The strength of value-based care hinges on physicians making correct diagnoses, which could open the door to lawsuits and incorrect treatments. Providers are also not paid as quickly with a value-based model, and reimbursement might be delayed depending on the patient’s treatment.

Value-Based Care vs Other Healthcare Delivery Models

Value-Based Care vs Fee-for-service

A fee-for-service model is a traditional healthcare model that compensates providers based on the number of services they perform rather than the quality of care. The criticism of this type of model is that providers could be incentivized to order unnecessary tests and administer services that aren’t necessary for long-term success.

These issues end up penalizing patients, increasing costs, and wasting time. With a value-based care model, providers are not incentivized by the number of patients, but by the quality of service they provide and the holistic, long-term success their patients achieve. 

Value-Based Care vs Pay-for-Performance

A pay-for-performance model is a part of the overarching strategy to transition providers to a value-based healthcare system. While pay-for-performance still has fee-for-service components, it encourages providers to deliver value-based care because it ties reimbursement to an outcome based on specific metrics. 

This strategy encourages providers to use best practices to improve patient satisfaction and align payment with quality. Although traditional fee-for-service models represent a significant percentage of income for healthcare practices, the shift towards pay-for-performance models and similar is accelerating rapidly. 

Value-Based Care vs Managed Care

Managed care refers to prepaid health plans that deliver treatment through a network of providers under a fixed umbrella of costs. Managed care is typically billed through an insurance provider, and patients pay a monthly rate to see providers within their allotted network. 

HMOs and PPOs are good examples of managed care, and a large portion of Americans have one or the other to manage their healthcare. Managed care differs from value-based care in that patients are limited to their network and make appointments based on which providers are available to them.

Value-Based Care vs Bundled Payments

Bundled payment models require a single payment for services given during an entire treatment episode. Providers are collectively reimbursed for the expected costs to treat a specific condition that may require visiting several physicians, settings of care and locations, and procedures. Bundled care is convenient for practices that have multiple types of physicians with different specialties so patients can get everything they need from one location.

Value-Based Care vs Capitation

Capitation is a healthcare payment system that is an alternative to a fee-for-service model. In a capitation system, a physician is paid a fixed amount per patient for the agreed period of treatment. 

Capitation is used by care organizations to decrease unnecessary spending and control the costs of care. Although this model can help reduce the financial burden and speed up quality care, it can also put the physician at risk if health conditions are not met during the allotted period. 

A benefit to this model is that providers don’t have to wait to be reimbursed, and they can cut costs on bookkeeping because they are being paid a set amount every month. With lower bookkeeping costs, a practice can be more productive while treating patients at a lower operating cost. 

Future of Healthcare Delivery and Payment Models

Although a complete value-based care model may take time to implement, practices should continue to focus on the experience they provide their patients and invest in tools to improve it. 

Software like Weave is designed for the challenges of a small healthcare practice. Many practices operate with limited staff and feel increased pressure from patient demands. With tools like Weave texting, digital forms, and automated reminders, your practice can deliver value to your patients.

Healthcare practices can also take advantage of flexible payment models with text payments and Buy-Now-Pay-over-time options. Both tools give your patients convenience and help them get the treatment they need without the hassle.

Stop letting unscheduled treatments walk out the door because of cost and sign up to become a CareCredit provider directly through Weave today. Give your patients the flexible financing options they need to accept care, and empower your staff to seamlessly process those payments right within your existing Weave workflow.

Conclusion

The future of every healthcare practice hinges on the patients that are being treated and the experiences they have. Providers should prepare for the shift toward more value-based models and put systems in place to support a smoother transition.

Weave helps small medical practices improve the patient experience with digital tools to automate and simplify communication. If you are curious about how Weave can improve the patient experience, book a free demo and see for yourself.