The Transition of Healthcare from Volume to Value-Based Care Models

A lot has evolved in technology over the last few decades. Healthcare providers are now primarily focusing on building a patient-centric model wherein data analytics are considered to plan proactive care techniques. The transition care process herein focuses on evolving care models by transitioning from volume-based, i.e., quantity-based systems, to value-based preventative care models.

This article discusses the potential of transforming from volume-based to value-based care models, the process and its advantages pertaining to quality care delivery.

Volume vs Value-based care models: What are the significant differences

Volume-based care can be defined as fee-for-service care. Herein, it includes a payment model where the providers are reimbursed based on the services and procedures they have availed for.

• Value-based models are more inclined toward providing tailored therapy
• It focuses on patient needs to establish a personalized program
• Patient outcome is a priority for value-based models
• It produces volume without enforcing productivity needs

On the other hand, value-based care is more based on the outcomes. For example, a patient prone to developing a cardiac ailment is educated about the risk factors by nutritionists, etc., to better their health.

• Volume-based models are inclined towards developing productivity standard
• It focuses more on the quantity of services provided
• It witnesses a higher number of patients each day and more therapies
• It produces volume by enforcing productivity requirements

The primary difference between volume-based and value-based care is that the latter emphasizes providing preventative care, thereby reducing the cost incurred. Whereas a value-based system incentivizes the patients to avail of better treatment.

The transition from volume to value-based care

Transitioning from volume-based to value-based care majorly involves the contribution of healthcare providers and patients. Herein, the transition is not only for the provider but also beneficial for the patient. Therefore, the prime motto of changing from a volume-based to a value-based model is to provide patients with efficient and better health care.

In volume-based care, a healthcare provider is paid based on their service. In comparison, value-based care gives more importance to providing quality care to enhance the outcome of care. Additionally, a value-based model motivates healthcare providers and patients to maintain their health and address other considerations such as managing BP, taking care of nutrition and much more.

The Transition must be well categorized to ensure better health outcomes against the total cost. It is achieved in five steps, including:

• Selecting the patient population with a higher risk of hospitalization
• Building an appropriate care model customized as per the needs of patients and providers
• Creating a model in coordination with collaborators, hospitals, caregivers, insurers, etc.
• Planning ways to reduce unnecessary variance, costs and drive utilization
• Monitoring progress and analyzing its impact on the population, along with suggesting ways to improvise

A value-based care model addresses Social Determinants of Health (SDOH)

A value-based model caters to compensating providers according to the outcome instead of paying for the services taken up. Additionally, the model addresses social determinants such as the patient’s economic stability, healthcare, education, environment, etc. It considers the factors that help understand the patient’s health, complications, and mortality rates, thereby building strategies to improve the outcome. Based on the same, the healthcare providers can list initiatives such as increasing nutritional values, creating meal plans, partnering with food banks, etc., to deliver enhanced health outcomes.

The challenges in Value-Based Care Models

The healthcare industry requires a general shift from a volume-based to a value-based module. Irrespective of the growth in value-based payment modes, most healthcare systems rely on doctors’ pay per volume to avail treatments. Thus, there are challenges faced in transitioning from volume to value-based models.

Below are highlighted challenges that hinder the shift to value-based care models.

Challenge 1: Mismatch of compensations in value-based incentives

There is a more significant push towards alternative payment methods that reward the doctors as per the value and quality of care. Yet the compensation acquired by physicians based on value-based methods is very meager. The incentives are largely volume based designed to maximize revenue.

Challenge 2: Lack of Integrated System

Employing outdated, isolated technology poses a major challenge in Transition. Herein, integrated solutions assist in introducing an efficient workflow. For example, integrating an EHR (Electronic Health Record) for patient engagement software helps in making quality clinical decisions and performing predictive analysis.

Challenge 3: Lack of internal resources

The lack of internal resources is a significant concern for value-based Transition. Insufficient technology, inefficient administrative service, and slow adoption of value-based care lead to increased operating costs and a lack of automation.

Challenge 4: Poorly managed patient care

A lack of coordinated patient care transition leads to higher operational costs, negative outcomes and adverse health. For example, when patients are transitioned from one setting to another, it is important to coordinate with the patient’s care provider, clinicians and therapists. It is necessary to be updated about the patient’s health history, issues, treatments and much more to provide a better value-based model.

The future of value-based care models

Value-based payment modules have grown over the years in the healthcare landscape. Herein, a value-based care model promises an improved medical and cost management process. It supports creating an enterprise value corresponding to improved outcomes, proactive patient care and enhanced patient care.

Additionally, the future of value-based models deems to be more integrated with specialty care, primary care and managed service organization. It is mainly emerging in specialties such as oncology and nephrology to render patient value-based care by integrating technology with patient care.

Overcoming Challenges of Value-Based Care with Technology

The above-listed challenges can be tackled by integrating care with technology. Integrating patient engagement with EHRs and other systems support an enhanced value-based care transition. Implementing the right technology, health practices and addressing the obstacles assist in planning a better solution and increasing quality patient care.

We at Equipo provide a lucrative platform to help healthcare providers and patients implement value-based care models to ensure enhanced healthcare and reduced costs.