Value-based health care is a health care delivery model in which providers, including hospitals and physicians, are paid based on patient outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease and live healthier lives in an evidence-based way.
Value-based care differs from a fee for service or capitated approach, in which providers are paid based on the amount of healthcare services they deliver. The “value” in value-based health care is derived from measuring health outcomes against the cost of delivering the outcomes.
The shift from volume-based to value-based health care is inevitable. Although the trend is happening slowly in some communities, payers are increasingly basing reimbursements on the quality of care provided, not just the number and type of procedures.
A colleague of mine and member of the Medical Management Association recently stated, “We’ve finally reached a point where we’re talking about what’s valuable in health care, compared to what could be considered redundant and/or wasteful.”
One area of health care that I feel has great potential to offer high value is comprehensive home-based primary care (HBPC). HBPC programs provide appropriate care (primary, urgent, or palliative) to high risk, medically vulnerable patients often suffering multiple chronic conditions, when and where they need it. This patient-centric, continuous care model delivers clinical, economic, and human benefits such as:
1. Facilitating timely interventions when chronic conditions worsen and preempting avoidable emergency department visits and hospitalization;
2. Alleviating social stressors that contribute to poor health;
3.Comforting patients by giving them loving care and letting them know they are not alone.
The aging population and the shift to value-based payment models are arguably two of the most disruptive forces in health care. Yet, payers and providers too often fail to see, monitor, and manage those individuals who will disproportionally affect the impact of this gathering storm.
They are the “invisible homebound,” an estimated 2 million and growing. They are frail, functionally impaired and vulnerable adults who are unable to visit their primary physician’s office, have severe functional impairments, disabilities and/or multiple chronic conditions, may require palliative or end of life care, often are not cared for by disease-specific management programs and account for approximately half of the costliest 5 percent of patients.
By offering accessible and convenient house calls HBPC providers work in partnership with interdisciplinary teams that can include primary care physicians, nurse practitioners, physician assistants, nurses, social workers, emergency medical technicians and pharmacists.
Beyond value to patients, home-based primary care delivers economic value to the health care system. By seeing these unstable patients regularly and taking full ownership of their healthcare, we’re able to minimize unnecessary hospitalizations, diagnostic testing and specialty care.
It is estimated that the average cost of a house call is $150 and the average cost of hospitalization for this patient population is 100 times more, you can start to recognize the value of this model.