Value-based care: A revolutionary health care payment model

In 2007, Netflix revolutionized the way we consume our entertainment media. It was an immensely successful — and equally risky — move that opened the doors for multiple streaming platforms to offer slightly different programming for the viewer. But some may argue this new direction also came with a downside. Today’s consumer pays for an average of four streaming services for a fragmented at-home entertainment experience, switching between platforms and typically spending more than they initially did on cable.

Despite the variety of choices available to viewers, the frustration of rising monthly fees, the struggle to remember passwords across platforms, and the ongoing challenge of finding something to watch is a shared experience for us all.

In many ways, this media fragmentation mirrors the state of our current health care system. We have multiple payers, all with their own networks. Patients must visit different facilities for the services they need, and individuals with multiple comorbidities are treated across a multitude of care environments, creating confusion in a system that lacks communication and shared data. The result is not only care that feels disjointed, but also strained resources and higher health care expenditures.

This problem may seem overwhelming, but there is a positive shift occurring. The value-based care (VBC) model bridges gaps in a broken, disconnected system and has the potential to positively impact health care economics.

Not your father’s value-based care

But if VBC is going to revolutionize how we deliver health care, it’s essential to understand that today’s model “isn’t your father’s VBC.”

“VBC 1.0 left many primary care physicians with a negative impression. During that first experiment, they were asked to meet lofty quality metrics and improve patient outcomes,” says Clayton Meyers, vice president of finance at Honest Medical Group. “But they had few resources available to achieve those goals. So, their reluctance about signing up for another shared-risk payment model is understandable.”

But, today’s model is different.

Meyers says VBC arrangements now offer more tools that empower primary care physicians to truly practice medicine again and support an improved physician and patient experience. Technology and data — including access to performance, patient attribution, and site-of-care — create a more complete picture of patient management and allow physicians to identify the high-resource patients who require the most care and benefit from the VBC approach. With improved workflows, physicians can better manage care transitions and deliver the proper care to the right patient at the correct location.

“This approach importantly expands the four walls of the clinic into the patient’s home,” Meyers says. “For many patients, meeting them where they are significantly increases their access to needed services and helps physicians identify and address pervasive gaps in care.”

The new VBC version also makes it easier for primary care physicians to relinquish the familiarity of the fee-for-service model that pays them for every service. These physicians embrace delayed gratification under this compensation model, but the payoff is worth it, Meyers explains. “Over time, primary care doctors make more money devoting less time to low-acuity patients and dedicating additional time to patients who require more resources and complicated treatments,” he says.

Impact on health care economics

Embracing this payment model has the potential to reshape the current health care landscape.

“We frequently refer to PCPs as the quarterback of a patient’s care — the provider responsible for managing and leading all care decisions,” Meyers says. “Despite this heavy responsibility, primary care physicians aren’t incentivized under the current fee-for-service model like specialists. And that’s created a problem.”

The United States faces a projected shortage of 124,000 primary care physicians by 2034. By awarding credit and compensation for successful preventive services, VBC can entice more doctors to choose primary care.

Recent health care spending reports prove the VBC payment model could save billions of dollars in Medicare Fee-for-Service spending alone. In addition to lowering the overall cost of care, side-stepping extensive expenditures on complex, costly treatments could free up funds that could be allocated to other government programs, including Social Security or infrastructure priorities.

The Honest difference

Within this new and evolving VBC environment, primary care physicians and facilities need a reliable partner to integrate successfully into the model. Honest Medical Group presents that opportunity for a unique collaborative experience.

Honest is committed to helping large and small groups — independent physician associations and health systems alike — thrive within the VBC environment.

“In our approach to joint venture governance, everyone has a seat at the table. Neither party can overrule the other,” Meyers says. “This way, as the pressures to consolidate or merge bear down, we can help the independent primary care physician and the larger health system regain and retain their independence.”

And because Honest believes health care is hyper-local, we evaluate each new partner’s existing infrastructure of the provider or facility and its surrounding community. Company experts identify where it’s possible to build on existing resources and initiatives working well and pinpoint areas where redesigned solutions can deliver better care.

There’s no doubt that initial experiences with VBC lend to a prevailing hesitancy for many physicians and facilities. But this payment model has evolved, Meyers says. Today, its targeted focus on quality starkly contrasts the fee-for-service approach and makes this new model an opportunity for provider groups and facilities of all sizes to come together, elevate patient care, and deliver an improved patient — and provider — experience.

Don’t change the channel on what VBC has to offer you, connect with Honest today to learn more about the collaborative partnership that can help you and your practice succeed in the shift to value-based care.