Value-Based Care in Today’s Health Care Environment

February 11, 2024

Value-Based Care in Today’s Health Care Environment

By Carl Brodarick, AccentCare – SVP-Hospice Sales/Managed Care Contracting

If you ask health care leaders in various industries what value-based care means to them and their teams, you will receive a plethora of definitions. If you ask a patient to define what value-based care is, they may give you a confused look and say, “Well, I hear Walmart has doctors at some of their stores.” The term value-based care is still evolving. Depending on which side of health care you sit, it means different things to different people. My definition, that I base our strategies on, is simple. Value-based care is providing the best possible coordinated care using the most efficient resources and defining care with exceptional patient outcomes.

Defining who pays for value-based care is critical to understanding the concept. The first meaningful payment model was introduced with the Patient Protection and Affordable Care Act in 2010. Its goal was for health care providers to work together in the U.S. to deliver quality care at a lower cost. Accountable Care Organizations (ACOs) were formed and were early entries into the value-based care concept. ACOs began to mimic Medicare Advantage health plans as they took risk from Medicare. To have a successful ACO, systems need to be able to access and analyze data across their clinically integrated organizations.

ACOs evolved and developed other Medicare risk models such the ACO REACH program. ACO Realizing Equity Access and Community Health is the most recent version CMS has developed. In this model the ACO must develop and implement a health equity plan and collect and report demographic and social determinants of health data for their aligned beneficiaries.

Government and private payers are looking for solutions to lower the costs of health care. The industry is tasked with delivering lower per-capita cost, generating higher quality outcomes, and creating healthier population models. AccentCare is a well-rounded post-acute company that works to meet patient needs while utilizing valuable health care dollars. While value-based care is a relatively new concept, AccentCare’s care model has operated in this capacity since its inception. Home Health and Hospice operate on a capitated type of model, receiving a preset rate structure for Home Health and a per diem for Hospice.

While Medicare Advantage insurance programs don’t market themselves as value-based care organizations, they do operate on a per member, per month rate provided by CMS. This capitated rate structure motivates insurance companies to look for efficiencies in the health care system. They look for opportunities to cut costs while maintaining high quality of care. They utilize community-based palliative care, offer preventive screenings, and develop clinic-type models that their enrollees can utilize versus being admitted to an acute care facility.

One key to our delivery success is providing outcome-based data to our referral sources. We can prove we can help our referral partners reduce burdensome transitions of care and unnecessary hospitalizations, thus creating value-based relationships, while we keep our patients in the home setting, where our patients have always preferred to be. We are the value-based health care option that cares for patients in their home while using minimal amounts of the health care dollars.