Are We There Yet? Let’s Talk About Value-Based Care in Behavioral Health
To paraphrase a quote from Steve Jobs: Quality is better than quantity in the same way that a home run is more valuable than two doubles. Value-based care (VBC) is a delivery model of health care in which healthcare providers are reimbursed based on the quality of the care they provide rather than the volume or quantity of services they render. In this case, the value of the home run is better health outcomes and reduced spending, and VBC does this by focusing on quality and promoting preventative care.
In a value-based care model, healthcare providers receive incentives to deliver care that is evidence-based, cost-effective, and tailored to the needs of individual patients. It often involves coordinating care across different providers and using data and technology to track and measure care outcomes.
For over a decade, the federal government, Centers for Medicare & Medicaid Services, and private health plans have focused on reducing healthcare spending by transitioning the healthcare industry to VBC payment models, starting with health systems like hospitals and primary care practices. There’s no doubt that specialties like behavioral health are next in line for the transition.
Let’s explore how value-based care compares to other healthcare delivery and payment models and review some strategies you can use to provide VBC, plus the technology that makes delivering quality patient care easier and more efficient.
Value-Based Care vs. Fee for Service
Value-based care and fee-for-service (FFS) are different healthcare delivery models with varying reimbursement approaches. A VBC model employs strategies to improve outcomes and reduce costs, while fee-for-service focuses more on volume than value.
Healthcare payers use VBC payment incentives to promote evidence-based, cost-effective, and patient-centered care by healthcare providers. Conversely, the fee-for-service models reimburse healthcare providers based on the quantity or volume of services they provide, regardless of their impact on health outcomes. The fee-for-service model may result in higher healthcare costs due to the overuse of low-value services that don’t impact patients' health.
Common Value-Based Strategies
There are several approaches to value-based care, including pay-for-performance (PFP) and accountable care organizations. These approaches all aim to align the incentives of healthcare providers with the goals of improving patient outcomes and reducing costs.
Pay for Performance
In a PFP model, clinicians have financial incentives to meet key performance indicators or KPIs, such as reducing the rate of hospital readmissions or improving patient satisfaction scores. PFP programs may use financial bonuses or penalties to incentivize quality care. These programs typically use data and metrics to track and measure the performance of healthcare providers and may involve quality improvement initiatives to help providers meet performance targets.
Accountable Care Organizations
An accountable care organization (ACO) is a value-based care system that reduces costs and provides better care by coordinating care delivery across different providers. ACOs may include a group of hospitals, doctors, and other medical professionals who work together to provide coordinated, comprehensive care to a specific patient population.
In an ACO model, healthcare providers are held accountable for the quality and cost of care. Specific performance targets, such as reducing the rate of hospital readmissions or improving patient satisfaction scores, ensure clinicians meet VBC goals. Providers in an ACO coordinate care and achieve these performance targets.
ACOs aim to improve the healthcare system's efficiency and provide patients with high-quality, cost-effective care. ACOs may use various approaches to care coordination, such as electronic health records (EHRs) or care management programs, to help providers work together more effectively.
How Do Bundled Payments Work in Behavioral Health?
An accountable care organization (ACO) is a value-based care system that reduces costs and provides better care by coordinating care delivery across different providers. ACOs may include a group of hospitals, doctors, and other medical professionals who work together to provide coordinated, comprehensive care to a specific patient population.
In an ACO model, healthcare providers are held accountable for the quality and cost of care. Specific performance targets, such as reducing the rate of hospital readmissions or improving patient satisfaction scores, ensure clinicians meet VBC goals. Providers in an ACO coordinate care and achieve these performance targets.
ACOs aim to improve the healthcare system's efficiency and provide patients with high-quality, cost-effective care. ACOs may use various approaches to care coordination, such as electronic health records (EHRs) or care management programs, to help providers work together more effectively.
The Role of Patient Engagement in VBC
Patient engagement is an essential component of value-based care as it can help to improve the quality of care and outcomes for patients. Patient engagement refers to the involvement of patients in their own healthcare decisions and managing their health.
In a value-based care model, patients are active participants in their care rather than passive recipients of care. Promoting patient-centric care can involve educating patients about their health conditions and treatment options, encouraging patients to take an active role in managing their health, and involving patients in decision-making about their care.
Patient engagement platforms like the CaredFor app can provide a patient education library. The CaredFor app provides patients with educational materials, such as videos and articles, to help them better understand their health conditions and treatment options. This action can empower patients to take an active role in managing their health.
The CaredFor app provides tools for care management. Care Journeys are digital roadmaps that improve outcomes and patient experience by helping patients stay on track with their care. CareJourneys can help to improve patient adherence and reduce the risk of adverse effects.
The CaredFor app also includes telehealth capabilities, allowing patients to connect with their healthcare providers remotely through video or audio calls, which can help improve access to care and reduce the need for in-person visits.
How EHR Supports VBC
A comprehensive electronic health record system can support value-based care (VBC) in several ways. First, EHRs give patients access to their health information and allow them to participate actively in their care. Through a patient portal, patients have access to their medical records and tools that enable them to communicate with their healthcare providers.
ContinuumCloud’s EHRs can also facilitate communication and coordination among different providers, helping to ensure that patients receive appropriate, evidence-based care. EHRs can also help providers track the progress of patients and close potential gaps in care.
Our EHR also provides data and metrics that you can use to track, measure, and report care outcomes, helping stakeholders identify areas for improvement and demonstrate the value of their care.
Lastly, by improving operational efficiency and coordination of care, ContinuumCloud can reduce the overall cost of health care. EHRs can help stakeholders identify and address unnecessary or low-value services and thereby lower costs.
Make the Transition to Value-Based Care Easier With Technology
For hospitals and primary care physicians, the move to value-based programs is in the rearview mirror — for behavioral health, changes are fast approaching. Delivering value-based care over a fee-for-services model takes preparation and time for transition. Technology can make the shift to value-based health care more accessible.
ContinuumCloud’s unified EHR solution supports the transition from traditional fee-for-service to VBC by providing a comprehensive, real-time view of patient health information and enabling providers to deliver coordinated, evidence-based care. The CaredFor app offers a range of tools and resources to help healthcare providers improve patient engagement and support value-based care. Connect with us today to learn how ContinuumCloud can support your transition to VBC.