19 Jan Is Value-Based Care the Answer to the Nation’s Healthcare Crisis?

Value-based care is a reality that service providers are going to have to deal with over the next two years. For behavioral health, it will bring some large and significant changes on how care is provided and paid for. But in primary care, value-based care is already a part of their system. Primary care is different than behavioral health care in how it is delivered, but some of the questions and challenges are the same. While looking at challenges in both primary and behavioral health, the method of payment becomes very important. Currently, most behavioral health agencies are being paid as a fee-for-service, meaning you provide a service and then bill for that service. In a value-based model, the organization will be dealing with capitated and bundled payments which provide a single payment for multiple services addressing a single condition.

There are many who see this move to value-based payment as the answer to the nation’s health care crisis. Behavioral health, like primary care, is guilty of some of the same issues. Quality of care, how is it measured by both groups, and the definition of “value” can vary. Before the quality of care can be measured, we need a better understanding of value and better ways of assessing value. For this to happen, we must be able to measure outcomes in the workflow from the patient’s perspective. Improvements are then rewarded in a value-based reimbursement system.

For many in primary care, a lot of enthusiasm has been expressed for value-based contracts, but these same providers are not sure how far they should stray from receiving fee-for-service reimbursement. Like behavioral health, value-based care is supposed to bring reduced costs, improve care, and boost patient satisfaction all at once. To make all three of those things happen at the same time will produce a lot of frustration.    

Electronic health records are supposed to make care easier, cheaper, and more fulfilling. Some providers see the use of electronic health records as a barrier to achieving value-based care. In some studies, it has been cited as a major cause of provider burn out. Given that there is no coordination or standard of what an electronic health record is supposed to provide in a value-based system, this would be true. Value-based care is going to need a measure of what good care is, and that will take us down the path of better value. In order to meet the challenge of providing better care, measurement of that care must be consistent. Electronic health records could help with the development of a consistent measurement process.

Another barrier to implementing value-based care is government regulation. If providers are going to be asked to provide quality care at a reduced price, then the provider should be allowed to decide the best method of care. The value-based model cannot be threatened by government priorities and programs. The system must be simplified and align multi-payer approaches to managed care. 

In the end, value-based care will lower cost, improve care, and lead to patient satisfaction. The obstacles are not insurmountable, but they will require programs to work together to design an improved system. To accomplish improved care, an electronic health care record must be outcome-driven and capable of evaluating the quality of care being provided. And, if patient satisfaction is going to improve, we must truly involve and hold the patient accountable for the care they are receiving.    

Value-based care is coming. Is your clinic ready?