Overview
Value-based care is a type of payment model centered on keeping patients healthier for longer, while curbing spending on low-value healthcare services.
While payment for “value” is many times seen as an alternative payment to paying for “volume” or fee-for-service, many practices pursue payments in both spaces – diversifying their revenue streams.
| Type of Reimbursement |
Focus |
Incentive |
|
Volume
(Fee-for-Service)
|
Individual Patient |
Continue to Treat |
Value
(Capitation; Bonuses; Shared Savings; Bundles) |
Population Health |
Prevention |
Key Considerations
What is Value-Based Care?
Value-based care is a form of reimbursement that ties payments to quality performance, patient outcomes, and appropriate reductions in spending instead of the volume of services provided. The goal is to keep patients healthier for longer while curbing the nation’s unsustainable spending on low-value healthcare services.
How do value-based care arrangements work?
In value-based care arrangements, physicians contract with government or commercial payers to meet certain clinical and financial benchmarks, which are designed to promote proactive, preventive, coordinated care.
Satisfactory performance on these measures leads to bonuses, a share of any savings produced by keeping spending below benchmark levels, or higher reimbursement rates. Poor performance may result in reimbursement decreases or the need to repay a portion of any shared financial losses.
Why should my practice consider access value-based care payments?
There is a major shift in the healthcare landscape from volume-based payments (fee-for-service) toward value-based payments (bundles, capitation, shared savings, etc.). This shift is centered on value-based care leading to better outcomes for your patients, better care, improve the population’s health, and decrease unnecessary healthcare spending.
In addition, value-based care will provide you and your practice with an additional revenue stream, not based on the volume of healthcare you provide.
Value-based care is overwhelming, are there services to help?
Yes! There are many entities that can assist with best practices for successfully transitioning to value-based care. Below, Innovitae Solutions identifies a best-in-class vendor recommendation.
Vendor Recommendations
Innovitae Solutions has conducted a thorough vetting process to identify the best-in-class value-based care solutions for its California physicians. Based on this process, considering the level of tools, services, and platform quality provided, Innovitae Solutions recommends Aledade.
ALEDADE
Population health company that offers tools and services to help independent primary care practices and health centers succeed in value-based care arrangements.
REACH OUT FOR MORE INFORMATION HERE |
More information on each solution offering can be found here:
Aledade helps independent primary care physicians and health centers thrive while maintaining their independence by successfully transitioning them into value-based care. Aledade does this by helping physician practices join its physician-led Accountable Care Organizations, which achieve shared savings in the Medicare Shared Savings Program and payor contracts.
- Personalized and at-the-elbow practice transformation services
- “Aledade App”, providing powerful technology to unlock actionable insights for patient care
- Proven success in shared savings
- True partnership with practices
FAQs
No. Aledade works exclusively with independent primary care physicians and health centers that operate in the Medicare space.
ACOs are a group of physicians, hospitals and/or other healthcare providers that come together voluntarily to give coordinate, high quality care, to patients.
The concept of value-based care emphasizes patient outcomes rather than the quantity of patient visits. Physicians who participate in ACOs are able to coordinate with other physicians in the group, spending their healthcare dollars more wisely, and realizing better cost-savings. As a result, they are able to provide higher quality care at lower costs.
The MSSP was launched in 2012 to encourage providers to participate in value-based care. The MSSP allows hospitals, community health centers, physicians and other types of clinical professionals to band together into accountable care organizations (ACOs), or groups of providers, that are collectively required to meet clinical and financial performance goals for defined and attributed populations.
In 2018, the Centers for Medicare and Medicaid Services (CMS) made major changes to the MSSP and renamed the program Pathways to Success. With multiple tracks based on an ACO’s experience and revenue volume, Pathways to Success aims to ensure that more and more healthcare providers can successfully transition to the value-based care environment.