What is value-based care, and is it right for your organization?
Special to the FMA from Aledade
Value-based care is a healthcare concept that primary care organizations should be reimbursed for improved patient health outcomes, which differs from traditional fee-for-service models where doctors and healthcare providers are paid based upon services rendered.
Americans pay more for healthcare in comparison to those in other countries, with recent studies indicating that health outcomes are not any better despite this expenditure.
In a value-based care arrangement, the primary goal is to keep patients well by meeting quality measures and specific performance metrics within value-based care contracts with Medicare, Medicaid and commercial health plans, in addition to the Medicare Shared Savings Program (MSSP). As a result, primary care organizations can focus on keeping their patients healthy while getting rewarded for it.
How does value-based care work in an Accountable Care Organization (ACO)?
Value-based care affects every aspect of a healthcare organization – from the waiting room to an in-office examination and when the patient is back home. Healthcare providers across the spectrum work within Accountable Care Organizations (ACOs) to embrace financial accountability while improving the quality of patient care.
Value-based care seeks to treat the patient as a whole individual with an emphasis on integrated care between providers to address health across the care continuum – physically, mentally and socially.
In ACOs, reimbursements are directly tied to meeting quality measures and reductions in the cost of care through this whole, patient-centered care approach. ACOs also offer opportunities to access patient programs, value-based care contracts with leading health plans, optimized workflows through technology and state policy guidance and expertise.
What is the MSSP?
The Centers for Medicare & Medicaid Services (CMS) started the MSSP in 2012 in support of fostering collaboration through ACOs in value-based care. Through the MSSP, primary care organizations focus on improving the quality of care for a defined patient population while achieving shared savings and fee-for-service (FFS) revenue.
With six risk tracks and two revenue streams, healthcare providers, hospitals and physicians can participate within an ACO that has at least 5,000 Medicare FFS beneficiaries in each benchmark year while meeting program requirements and expectations for success.
Should I join an ACO?
Making the decision to shift from volume to value in value-based care may enable primary care organizations to provide better patient care while earning shared savings for lowering healthcare costs.
Aledade, the nation’s largest network of independent primary care, works with primary care practices and clinics like yours to earn shared savings in the MSSP and health plan ACOs. To learn more about value-based care and whether joining an ACO is right for your organization, visit www.Aledade.com or email Amanda Foster, senior network development lead at Aledade, at afoster@aledade.com.