Providers are busy… operators need to boost visit volume and close value-based care gaps… staff are tired.
Have you considered support to complete comprehensive visits for your patients, even the hard-to-reach or not currently seen this year?
EasyHealth’s aim is to promote better clinical outcomes in value-based care through completing comprehensive clinical profiles.
Value-based care aligns incentives for operators and providers —
Better patient care leading to improved clinical outcomes becomes capital for providers. Value-based care is designed to change the incentives driving our actions.
This vlog post introduces you to value-based care and how it lets providers take equity and capture returns in patients’ health.
The Old Model: Fee-for-Service Care
The old model of healthcare is called fee-for-service healthcare. Under this model, providers are paid for each service or item that they provide. This means the more services patients need, the better it is for healthcare providers who get to make money off of patient care instead of providing quality care.
The fee-for-service system has been widely criticized by health insurance companies and other stakeholders in today’s medical world. David Duel is the founder and CEO of the 400-person medicare platform EasyHealth, which has established its place in the healthcare industry through technological innovations and efficiently combining healthcare and insurance services. David Duel explains, “Under the fee-for-service model, medical providers end up making more money when patients are sicker. This means hospitals and health systems are incentivized to treat patients when they’re sick, not perform wellness checks and screenings to make sure they never get sick in the first place.”
What Is Value-Based Care
Value-based healthcare providers are paid for outcomes rather than services, so they need to focus on providing better health outcomes and not just performing medical procedures or prescribing medications. This aligns healthcare provider incentives so both the patient and the healthcare provider are incentivized to keep the patient healthy in the first place.
In the past, providers were paid for all of the services they provided. Now, doctors and hospitals are paid a flat fee per patient or bundled payment that is related to specific medical procedures. This way, providers make money when patients stay healthy instead of providing more healthcare services in an effort to keep patients well enough to return again and spend even more money on care.
Value-Based Care for Health Insurance Providers and Policymakers
Health insurance companies have been slow adopters of value-based healthcare because it means less revenue since they’re only paying out a lump sum versus charging premiums each month. However, health insurance companies can use data from provider organizations’ yearly outcome reports so they know which plans provide better outcomes at lower costs before deciding who to insure.
Policymakers are also looking at value-based healthcare as a way to lower costs for everyone, including patients who are currently paying out of pocket or are insured through government programs. Payers can use data from Provider organizations’ yearly outcome reports to see which plans provide better outcomes and charge premiums accordingly.
Value-Based Care for Health Insurance Companies
David Duel adds, “Health insurance companies should be the early adopters of value-based care since they’re getting paid less, but their risk is decreased because they know that provider organizations have good underlying health metrics before insuring them.” This means providers will want to keep patient populations healthy so claims don’t go up too much each year and payers won’t drop them due to poor performance on quality measures.
Why Are Some Doctors Hesitant to Adopt Value-Based Care?
Some doctors are hesitant to adopt value-based care because they worry about getting lumped into the same category as hospitals or providers who have had poor performance in quality measures. This means that patients may not want to go where the most money is being spent, even if it’s a high-quality facility.
The good news is that by looking at outcome data from individual procedures and medical cases, payers can see which provider organizations perform well on certain metrics before deciding whether or not they should be insured. Providers will also need to make sure their financials look great so insurance companies don’t start charging them more for new policies based on poor results over time instead of one bad year.
Value-Based Care Is Here to Stay
Value-based care is here to stay because it’s a better way for patient outcomes and healthcare providers’ incentives are aligned. Payers will want the best results from provider organizations so they can insure them, while doctors and hospitals have an incentive to keep patients healthy instead of prescribing medications or performing procedures if something goes wrong with their health.
For more info on EasyHealth and David Duel, see : Medicare startup EasyHealth gets $135M in series A to fill information gaps