Value based care is a type of reimbursement in which paymentsare made for the delivery of care and the quality of care that wasgiven. This form was also created to reward the providers with bothefficiency and effectiveness for the level of care provided. Overthe years, value based care has become a type of reimbursement that“has emerged as an alternative and potential replacement forfee-for-service reimbursement” (LaPointe, 2016). Fee for servicereimbursement promoted quantity over quality in terms of thedelivery of care, so as a solution federal officials proposeddifferent solutions to this, and one of the solutions was to rewardhealthcare and medical professionals for proper and quality care.Thus, the idea of value-based care emerged and was proposed as away to put quality over quantity of services to “triple aim ofproviding better care for individuals, improving population healthmanagement strategies, and reducing healthcare costs” (LaPointe,2016). Value based care’s benefits are overwhelming, it lowerscosts and provides patients with better outcomes, for providers itincreases patient satisfaction and provides better careefficiencies. For payers it provides them with stronger costs andreduces the amount of risks, for suppliers it aligns the prices ofthe services with patient outcomes. Finally, for the societyoverall, it reduces healthcare spending and provides the societywith better overall health.
A specific example I found through my research was of CMS,Centers for Medical and Medicaid Services. They have 5 programs forvalue based care in which their goals are to link providerperformance of quality measures to provider payment. Their 5original programs include; End-Stage Renal Disease QualityIncentive Program (ESRD QIP), Hospital Value-Based Purchasing (VBP)Program, Hospital Readmission Reduction Program (HRRP), ValueModifier (VM) Program (also called the Physician Value-BasedModifier or PVBM), Hospital Acquired Conditions (HAC) ReductionProgram. CMS uses these programs as “part of our larger qualitystrategy to reform how healthcare is delivered and paid for.Value-based programs also support our three-part aim, better carefor individuals, better health for populations, lower cost” (CMS’Value-Based Programs, 2020).
This organization bases their criteria on multiple factors. Someof the main factors include; payment (such as coverage of services,report, quality), program integrity (fraud and abuse enforcement),quality and public reporting ( cancer hospitals, inpatient &outpatient quality, nursing home agencies), and qualityimprovement. Value based care’s benefits are overwhelming, itlowers costs and provides patients with better outcomes, forproviders it increases patient satisfaction and provides bettercare efficiencies. For payers it provides them with stronger costsand reduces the amount of risks, for suppliers it aligns the pricesof the services with patient outcomes. Finally, for the societyoverall, it reduces healthcare spending and provides the societywith better overall health.
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