HEALTH CARE

news What is value-based care and why is the healthcare industry suddenly interested in it?

Value-based care (VBC) has become an increasingly popular buzzword, gaining a lot of attention and press on the “future of healthcare.” Many start-ups, large health insurers, provider groups, hospital systems, and even technology companies want to invest in VBCs.

But what exactly is value-based care?

The term VBC specifically refers to quality When “worthof the care provided to the patient, rather than amount of the care provided. An article in the New England Journal of Medicine called it a “health care delivery model in which providers, including hospitals and doctors, are paid based on a patient’s health. , will be rewarded for reducing the impact and incidence of chronic disease and helping people live healthier lives in an evidence-based manner.” occurs. Rather than rewards being linked to the amount of care, VBC incentivizes clinical outcomes.

This is in contrast to the rigid fee-for-service (FFS) approach that many organizations and healthcare systems are currently taking. With FFS, providers are paid per step or actual service provided.

Naturally, there are proponents and detractors of both methods. Critics of the FFS say how the model incentivizes providers to order more tests and engage in more procedures, even if unnecessary, as a means of boosting profits. are discussing. VBC critics, on the other hand, show that there is no systematic infrastructure in place to justify value-based care. For example, if a patient sees a doctor for wrist pain, the true meaning of the VBC model is that the doctor is also tasked with counseling this patient on topics related to lifestyle changes such as smoking cessation and weight loss. increase. While this is certainly a valuable aspect of care, that same doctor may have perhaps 40 patients on the waiting list for the day, and such value-driven counseling poses significant time constraints. occurs.

Businesses, healthcare organizations, and governments recognize the limitations of different care delivery models, but have recently been eager to move to VBCs as healthcare pricing is rapidly disrupting. Many startups are actively trying to get into the VBC space. Take this He CareBridge, for example, which raised about $140 million in one year. The company “helps health plans and states in the care of individuals receiving home and community-based services” and “its solutions include 24/7 clinical support, decision support, data aggregation, and electronic visits.” Includes validation.”

Several other startups are looking to work on VBC initiatives in specific areas of care. For example, Somatus works with health plans, healthcare plans, and provider groups to provide “integrated care for patients with or at risk of developing chronic kidney disease or end-stage kidney disease.” I’m here. Leveraging key partnerships and advanced data tools, the company aims to create a comprehensive ecosystem for patients needing kidney-related care.

Even some traditional payment organizations are embracing VBC as the next revolution in healthcare. As his Aetna, one of the world’s largest payers, explains: Patients cannot navigate the healthcare system on their own. The care team is there to support their healthcare journey. Teams are expected to focus on prevention, wellness, strategy, and coordination across the continuum of care, a priority of particular importance to those managing chronic diseases.multidisciplinary care team They may include case managers, mental health professionals, social workers, pharmacists, nutritionists, educators, psychologists, health coaches, administrators, and more. Not all team members provide direct care, but they work with patients and caregivers to help identify and address each individual’s medical needs. To help solve problems and improve overall health care. “

Indeed, the purpose of pursuing VBC is to create a proactive and holistic approach to care delivery, ultimately treating the person, not just the symptoms.

However, as mentioned earlier, there is still a significant amount of work left on the infrastructure to support VBC. This model requires significant buy-in from relevant health professionals, as well as significant resources such as administrators, specialists and primary care professionals. Moreover, this will only happen if regulators, policy leaders, and executives can convince the public that VBC is worth pursuing, especially as FFS experts continue to highlight its disadvantages. Effective.

However, migrating from one system to another does not happen overnight or smoothly. Rather, the creation of hybrid models that seek to emulate the best parts of both systems, ultimately to best serve patients and the community as a whole, is likely to occur.

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