The U.S. healthcare system is one of the most expensive and least effective among developed nations. Things that are cheap in other countries are outrageously expensive in the U.S. (such as a MRI which is usually around $1,000 in the U.S., whereas in Australia it is only $350), and per capita expenditures are almost twice higher than the expenditures of other nations. Together with expensive treatments and medications, the U.S. healthcare suffers from bureaucracy and administration inefficiency due to which patients may wait weeks for medical help. Administrative costs, which normally range between 1% and 3% of overall healthcare expenditures in other countries, come to 8% in the U.S.
Inefficiencies of the existing system result in worse patients’ care and experience, making changes in the healthcare industry inevitable. Encouraged by the reimbursements from Centers for Medicare and Medicaid Services (CMS), the industry is moving toward a new model called value-based care that focuses on people wellness, disease prevention, and less chronic illness in the population. Unlike the former fee-for-service model, where payments are made for the number of procedures performed, value-based care emphasizes treatment quality and patients’ experience.
In most cases traditional care is reactive, focusing on an injury or disease. Often patients have to manage the care by themselves, scheduling appointments and explaining their symptoms each time when they meet a new physician. One more problem is that patient care is not coordinated with other professionals.
Value-based care puts the patient at the center. Proactive care aims to prevent diseases and delay chronic conditions. All organizations are encouraged to adopt new technologies for safe and easy health data access and availability across the network.
There are more than 40 various models of value-based care recommended by CMS. Three features, such as financial risk, quality assessment, and care coordination, are common for them all.
Providers are required to assume a financial risk to make sure they deliver care of sufficient quality to the patients. For example, bundled payment sets one price for typical treatment. A provider should perform all the needed procedures and tests to manage the patient’s condition. If he can do it under lower costs, he saves the remaining money, if not, the difference is not reimbursed to him.
In most cases, reimbursement requires a provider to meet a certain quality level, which can be assessed by the number of patient’s readmissions, patients’ satisfaction, etc.
Focusing on patients’ data exchange and availability across the network, value-based healthcare promotes collaboration between various providers and representatives of the healthcare system. This reduces the time a patient spends on waiting for referrals and treatment authorization. In other words, it results in more efficient communication and timely treatment.
Value-Based Care Delivery
Though the number of U.S. states and territories implementing a new model has spiked in recent years, many organizations report barriers to succeeding in value-based reimbursement. According to the HealthEdge, 28% of the interviewed organizations considered patient engagement the biggest barrier, while 24% named first technology and infrastructure. Despite 40 different models suggested by CMS to make the implementation possible for any organization, some factors keep organizations from efficient value-based care delivery.
The Chief Medical Officer and Regional President, North America of Solve.Care, Dr. David Hanekom, having almost 30 years of experience in medical management, named 5 things about the industry which he wished someone had told him before he started.
1. The impact that electronic medical records would have on the amount of time physicians would spend on documentation.
2. The need for IT to support managing the healthcare needs of practice panels and populations in the era of value-based care.
3. The need for robust point-of-care clinical decision support.
4. The need to incorporate payer business intelligence into provider systems to track and manage the cost and utilization metrics across populations in an era of value-based care.
5. The necessity for physicians to be leading the design and application of IT systems in applying technology tools in a clinical environment to ensure the tools meet the clinical and business needs of front-line clinical staff.
Solve.Care became the first company that combined blockchain technology and digital currency for value-based payments. By advanced health data encryption and automatization of such processes as referrals, insurance verification, and appointment scheduling, Solve.Care solutions allow ways around most of the barriers that organizations face when trying to adopt a new system.
Value-based care is one more step toward healthcare with the patient at the center. It replaces an inefficient and costly fee-for-service system and sets new quality and administration standards for all members of the healthcare environment.