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Marc Klar

By: Marc Klar on August 22nd, 2016

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What is Value Based Care?

Value-Based Care

Of course, your healthcare organization is set up as a business and you have to maintain good financial practices and standards to achieve your targeted range of revenue flow. But the work your team does is not designed primarily to make a profit as much as it is devoted to diagnosing, healing, and helping to maintain the health of each patient that passes through your doors.

In the United States, there is an increasing emphasis now to focus on delivering value based care instead of what is sometimes uncharitably referred to as volume-based care.

Value based care, simply put, has to do with focusing on patient care and positive outcomes rather than on the quantity of tests and procedures involved.

Since value based care is becoming an increasingly important topic in the medical industry, you’d be right in wanting to get up to speed. You can feel more confident in your organization’s approach once you take in this overview of value based care and its components.

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Why is Value Based Care Different?

Under the older quantity over quality methods employed in earlier periods in modern U.S. healthcare, it made sense to give a test even if the doctor didn’t think it was relevant or even proper, since a test allows you to cover your posterior in case something did go wrong. It’s easy to see how higher malpractice insurance rates and increasingly larger numbers of patients resorting to lawsuits after treatment can encourage medical professionals to batten down the hatches and use every piece of equipment and test at their fingertips.

Value based care means putting the patient first. For example, instead of ordering a slew of unneeded tests (beyond just to shield the practice from malpractice suits), physicians would only order what is actually needed for the patient’s well being.

Volume-based care will result in such waste as medical professionals order a redundant chest x-ray even though the patient just had one a week ago in an affiliated medical facility. Sometimes the problem stems from a simple lack of information or the ability for medical teams to share digital information about their patients.

Why Switch to a Value Based Care Model?

Why would your organization want to switch to a value based care model, when your revenue flow has been satisfactory and patient retention rates are in alignment with your business plans?

It’s important for your fellow stakeholders to understand that a patient centered model is actually better for everyone. Adopting this model allows your staff to focus on patients who need better quality care. One of the central benefits of value based care is providing more healthcare data to public health researchers. The anonymized data serves to show scientists undiscovered patterns when looking at population health. It can help us determine where to best deploy future medical research efforts.

What’s more, there is a definite financial incentive for you to go the value based care route. The U.S. government, in the name of efficiency and reigning in the budget, is now working on lowering costs involved in providing healthcare throughout the nation. Medicaid and Medicare started offering financial incentives to medical organizations that work to provide value based care rather than volume based care.

Part of this mandate to streamline efforts includes the government having each practice use certified electronic health record or EHR software in order to qualify for reimbursements. And the more streamlined your office is, the more resources you can deploy as well, such as hiring new physicians since support staff is now working more efficiently with less.

How to Succeed with Value Based Care

Begin by coming up with a model to follow, and staff accordingly. For example, some practices will aim for a Patient Centered Medical Home model. The term “home” refers to the practice that is the home of a patient. Following the PCMH model requires your staff to maintain standards for how many times and when they connect with patients to follow up on care, for example.

Brainstorm with your team to figure out which established model would be easiest for staff to transition to. Then, it’s time to establish goals so everyone involved will have a clear idea of what success looks like for your practice. A common goal involves reducing the number of after-care infections by allocating more staff time to nurse practitioners for showing patients how to monitor their progress.

EHR software streamlines the process to the point that you’ll be wondering why your organization took so long to computerize your office and take advantage of its efficiencies. Make sure that your EHR software is Stage 2 Meaningful Use Certified and ICD-10 Compliant. A system that follows current industry and government best practices will help move your medical practice into value based care with its ability to report details in accordance with MACRA (Medicare Access and CHIP Reauthorization Act of 2015), Alternative Payment Models, and MIPS (Merit-based Incentive Payment System).

Any medical practice that is still using a paper-based system or is trying to get by using generic office software will find that using certified EHR and other related medical applications will improve efficiency just as the government is now encouraging us all to do.

A change in focus to emphasize a patient-centered model in the way we deliver healthcare services in the United States means that we can expect higher quality and better outcomes while streamlining the work that must be done

Key Takeaway:

  • The United States is starting to adopt a value based care approach to taking care of patients.
  • A central idea of value based care is that it emphasizes efficiency and thoughtful action, cutting down on unnecessary procedures that doctors order primarily as legal cover.
  • Financial incentives to adopt value based care in your organization will deliver reimbursement from Medicare and Medicaid, but you must use certified EHR software to be eligible.
  • Follow-up contact in a structured way between doctor or nurse practitioner and the patient is one element of value based care that should result in better patient outcomes.
  • Establish efficiency goals as well as benchmarks for quality to make sure that your staff knows what the parameters are when emphasizing value based care.

Staying informed on the latest developments in value based care can be a daunting process when you are already occupied full time with running a medical practice. This is especially the case when it comes to monitoring industry best practices and potential changes in governmental regulations. To help you stay in the loop, click here to subscribe to the blog.


About Marc Klar

Marc has years (decades, actually) of experience in medical software sales, marketing, and management.

As Vice President of Marketing, Marc oversees the entire marketing effort for ADS (the MedicsCloud Suite) and ADS RCM (MedicsRCM).

Among other things, Marc enjoys writing (he’s had articles published in a number of healthcare industry newsletters and on websites), reading, cooking, and performing comedy which sometimes isn’t funny for him or his audience.

Marc is an accomplished drummer, has studied with some of the top jazz drummers in NYC, today plays with two jazz big bands, was in the 199th Army Band, and has taught drumming at several music schools.

Next: read our ADS and ADS RCM blogs, ebooks and whitepapers. They’ll stimulate your brain as well.