Medicare has been encouraging providers to adopt value-based care (VBC) over the traditional fee-for-service model for more than a decade now. The major advantages of VBC – substantial cost reductions, along with expanded access to care and focusing on the quality of that care over quantity of patients served – clearly benefit patients and providers alike.
Insurers have gotten on board, too. Humana, for example, has claimed an annual savings of $4 billion, partly because patients were able to receive screenings more frequently for conditions like cancer, spine disorders and blood glucose management. The report also said VBC initiatives led to a reduction of more than 200,000 total inpatient hospital days in a calendar year alone.
Congress accelerated the push for VBC in 2015 by passing the Medicare Access and CHIP Reauthorization Act (MACRA), which moved the government’s provider payment structure to a more performance-based model. This helped lead to a rise in popularity of accountable care organizations (ACOs), made up of provider groups who collaborate on patient care and are incentivized to meet quality and cost targets.
This is a clear shift from the fee-for-service (FFS) concept. For providers, though, value-based care has presented some challenges just as it has created improvements in efficiency and a deeper patient base.
Here are a few issues:
Manpower shortages: One reality of VBC is that an individual physician is often managing hundreds of patients. Their internal staff typically doesn’t have enough time to adequately handle this demand, even for basic procedures.
Technological deficiencies: Quality of care is a focus of VBC, but most providers aren’t equipped with sufficient software platforms (and tech-savvy administrators) to reach those quality thresholds consistently.
Fundamental shift in business focus: Physicians tend to gravitate to business as usual like everyone else, accustomed to established habits and procedures. And even without the shift from the traditional FFS approach, the Association of American Medical Colleges anticipates a major shortage of physicians in both primary and specialty care in the next decade. Being forced to adapt to a completely new payment model could complicate the situation that much further.
Yet despite some hurdles, VBC’s inherent cost reductions and greater provider access have helped transform the healthcare industry. CMS has pledged to extend its support of value-based Medicare Advantage through at least 2030, and ACOs are becoming a major player in the industry.
Many providers, too, are optimistic about the future of value-based care. One physicians advocacy group cites the model’s emphasis on coordination and prevention over volume of care as one way to avoid burnout as well as dramatically improve patient wellness.
It’s also important to realize there is help available for addressing manpower issues, by partnering with third party for meeting the basic needs of patients who may not require frequent trips to the practice.
HealthXL® specializes in the remote care side of the industry, reaching out regularly to Medicare-eligible patients to monitor their general wellness between office visits. Our Remote Patient Monitoring and Chronic Care Management programs are proven to reduce hospital readmissions and trips to the Emergency Department, and they’re reimbursable by CMS and private insurers.
With a reliable partner, providers don’t have to rely on a staff already spread too thin to check in with patients regularly – our licensed Care Coordinators do it for them, monitoring and recording their vitals and general well-being. We have countless stories of how simple phone calls have made a huge difference in helping patients manage their chronic conditions at home.
Our HIPAA-compliant proprietary software platform simplifies the process of accumulating and storing critical patient data, such as blood pressure readings, pulse rates, and sugar levels, along with personal observations from the Care Coordinators. This data is uploaded to the provider’s EMR, safely and securely.
We know first-hand how the shift to value-based care has increased the quality (and quantity) of life for patients and welcome the opportunity to share more specifics about what we do.
We call our patient-centric approach A Better Way to Care, and we’ve shown its power to practices of all sizes and scopes. Contact us here to learn more about what that truly means for you and your patients.