Value-based health care, in which a more holistic and collaborative approach to health care is adopted, has gained steam in light of the pandemic. In lieu of the traditional fee-for-service reimbursement model’s emphasis on quantity of care, value-based care emphasizes quality of care for patient-centered outcomes.
Implementing a New System
Back in 2016, the Centers for Medicare & Medicaid Services (CMS) implemented a pilot program, the Home Health Value-Based Purchasing (HHVBP) model, in nine states. The program, according to the CMS, is intended to incentivize Medicare-certified home health agencies (HHAs) to provide better patient care and outcomes at a lower cost by moving agencies away from the traditional fee-for-service model to an outcomes-based model. An evaluation report of the participants’ performance from 2016 to 2018 showed an average 4.6% improvement in Medicare-certified home health agencies’ quality scores and an average annual savings of $141 million to Medicare, according to Fierce Healthcare.
In November 2021, the CMS accelerated the shift to make value-based care a universal standard. The CMS rule finalizes a nationwide expansion of the HHVBP model and makes updates to the Medicare Home Health Prospective Payment System (PPS) and the home infusion therapy services payment rates for 2022.
How COVID Impacted Value-Based Care
The pandemic helped to improve the management of chronic diseases, which provides significant momentum for stimulating the growth and success of value-based care. According to a report by EY, economic logic favors fee-for-value (FFV) over fee-for-service (FFS) models. However, growth in value-based care has been hampered by operational difficulties that made few FFV agreements profitable for provider organizations. “The pandemic accelerated adoption of an environment in which value-based chronic disease agreements — the logical focus of FFV — can be managed effectively. Providers that continue to embrace innovation [such as virtual care] in patient care are likely to tap aggressively into this revenue stream.”
The availability of more data is also helping the shift to value-based care. According to HealthTech, health care organizations that have the technology to go through massive amounts of data and deliver critical insights to clinicians will lead in the transition to value-based care. Technology will help empower physicians at the point of care to provide better care for the patient. “Tech-enabled solutions should put as much data as possible at physicians’ fingertips in a curated way to help them make the best clinical decisions,” according to the HealthTech article.
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