What is Value-Based Care, and Why is it Important?

This blog was originally published in June 2022 and was updated in June 2023.

Value-based care has changed the face of the healthcare industry. But what is value-based care? And how can this model benefit physicians and patients alike?

Today, we will dive into value-based care to discuss its key components, benefits, and challenges. Then, we’ll show you precisely what you need for your practice to succeed in a value-based care model. 

What is Value-Based Care?

The Centers for Medicare & Medicaid Services (CMS) defines value-based care as programs that “reward health care providers with incentive payments for the quality of care they give to people with Medicare.” 

The shift to value-based payments from fee-for-service payments is essentially a shift to quality from quantity. No longer will physicians be paid for each service or each visit – instead, they are paid based on the quality of patient outcomes.

CMS began emphasizing value-based, quality healthcare over quantity of visits. In 2008, CMS initiated the Medicare Improvements for Patients and Providers Act (MIPPA) which partially rewarded eligible healthcare providers for electronic prescriptions. 

The following year, the Health Information Technology for Economic and Clinical Health Act (HITECH) was included in the American Recovery and Reinvestment Act of 2009 (ARRA). 

HITECH established programs under Medicare and Medicaid to provide incentive payments to eligible healthcare providers for the “meaningful use” of certified electronic health record (EHR) technology.

What is a Value-Based Care Model?

A value-based care model is one where hospitals and physicians are paid based on patient health outcomes. Providers are rewarded for improving the health of their patients, reducing symptoms of chronic diseases, and helping their patients live healthier lives on the whole. 

Value-based care differs from the traditional fee-for-service approach, where physicians are paid based on the amount of healthcare services they provide. 

Key Components of Value-Based Care

Value-based care is a healthcare model that:

• Repeals the Sustainable Growth Rate formula

• Rewards clinicians for value over volume

• Streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS)

• Gives bonus payments for participation in eligible alternative payment models (APMs)

Benefits of Value-Based Care for Physicians

How does value-based care benefit physicians? There are so many potential perks. Some benefits include:

Improved Patient Satisfaction

Patients report greater satisfaction when their physician focuses on their overall health instead of symptom management. 

When treating patients with the value-based care model, physicians can consider pre-existing conditions, diet, and environment and holistically treat their patients. This improves the doctor-patient relationship.

Increased Operational Efficiency

Lowered costs associated with the management of chronic illnesses will free up more budget to be used on efficient workflows. EHR and telehealth technology are just a few examples of how technology can make practices more efficient for both physicians and patients. 

Streamlining the workflow gives providers more time to focus on preventative medicine instead of constantly dealing with readmissions.

Better Supplier Relationships

When switching to the value-based care model, physicians may find it easier to get high-quality suppliers.  

Some suppliers specifically target healthcare practices that use the value-based care model. If they are confident that their medical equipment and supplies can provide good patient outcomes, they will get a bigger return when working with value-based healthcare. 

Challenges and Considerations for Value-Based Care

For independent physicians, following the changing regulations for reporting value-based care can be a significant challenge. CMS has shifted its focus between programs and, in fact, is seriously considering scrapping the Merit-Based Incentive Payment System (MIPS) that has been at the center of its value-based trend.

There are also obstacles to providing and reporting value-based care beyond the CMS uncertainties. Some of those obstacles – and their solutions – include:

Patient Engagement 

The ability to engage patients in their own healthcare is critical to the quality of their care. Communication with patients on their follow-up plans, clarifying instructions, and answering post-visit questions can increase that engagement. 

Arranging regular discussions with a care manager who truly understands their conditions and concerns helps to establish trust and engagement. This will deliver ongoing benefits in both patient satisfaction and physician insights.

Effective Care Management for “Super Utilizers” 

Independent primary care physicians are often faced with the challenge of patients who need to be seen multiple times for complex conditions. 

With so many chronic conditions being managed, 80 percent of healthcare costs are driven by about 20 percent of patients. In fact, approximately 50 percent of costs are incurred by just 5 percent of patients, aka Super-Utilizers. 

Behavioral Health Integration Services (BHI), and Chronic Care Management (CCM), both CMS programs, offer mechanisms for the primary care physician to manage the care of patients with chronic conditions more effectively.

Access to Sufficient Comprehensive Information

Coordinating care with specialty providers and having easy access to information from laboratories and healthcare facilities is necessary for quality value-based healthcare. An integrated, coordinated electronic health record (EHR) system allows independent physicians to do just that. 

Interoperable EHRs allow the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities.

While there may be some challenges to overcome when switching to a value-based healthcare model, there are plenty of proven value-based care solutions that can help you succeed in your venture. 

How to Succeed in Value-Based Care

The transition to value-based care from a fee-for-service model requires physicians to be prepared with the right tools. 

A survey conducted in mid-2016 showed that “only 29 percent of polled physicians stated that they have the tools necessary to function effectively in the world of value-based care payments.” Primarily, these tools consist of the technology needed to manage patient information and coordinate care with other providers.

Primary care physicians need information at their fingertips to gauge the quality of their patient care and to be able to report results. EHR is an essential tool for physicians to have, but to be truly effective, EHR systems must be interoperable. 

Patients with chronic or complex conditions, in particular, may see multiple physicians, so the primary care provider must have immediate and accurate access to those patients’ medical information to provide quality, value-based healthcare.

A tool such as Elation’s Collaborative Health Records (CHR) is designed to provide physicians with on-demand access to patient information from any provider in their network. CHR gives providers visibility into their patient’s complete care records for more accurate reporting on clinical quality measures and compliance for value-based reimbursement.

An EHR system enables the independent physician to manage patient care, as well as the practice itself, more efficiently and effectively. Having access to a patient’s complete medical record, including information from other providers, labs, and healthcare facilities, enables independent physicians to develop and implement a more complete overall picture of the patient’s care plan. 

Elation EHR Helps Physicians Succeed in Value-Based Care Models

Elation’s philosophy from the start has been to help independent physicians provide value-based primary care that benefits the patient and the practice. We recognize the enormous chasm between the world of policy and payers and the world of the front-line physician. 

We have built our solutions with a mission to strengthen the relationship between patients and physicians and enable phenomenal care for everyone. Elation’s EHR system can help transform value-based healthcare. 

In fact, one Elation user, Firefly Health adopted Elation EHR and built their own Patient Engagement app to help them group patients into cohorts and then use the clinical data to more effectively leverage member interactions. View the case study to see the full results.

If you are looking to succeed with the value-based care model at your practice, you can explore a sample chart in Elation EHR to see how it would assist your workflow.