Over the last decade, both employers and insurers have started to recognize the benefits of prioritizing "value over volume." In a traditional fee-for-service healthcare model, providers are paid based on the number of patients they see in a given day
Patient-centered or value-based care models, however, flip this concept — reimbursing providers for focusing on quality over quantity.
The Basics Of Value-Based Care
Value-based care models focus on an individual’s whole health, unique experiences, and needs. These models facilitate a more comprehensive view of patient health and can alter a provider’s reimbursements to be based on the quality of care they provide rather than the number of patients they see.
In a value-based or patient-centered care model:
- An individual’s specific health needs are the driving force behind their care provider’s decisions.
- Patients work together in partnership with their doctor, collaborating on treatment plans that not only benefit them from a clinical perspective, but also from an emotional, mental, social, and financial point of view.
- Doctors are paid for the overall value and outcomes they provide their patients. This can take the form of several different contract types, from accountable care organizations to bundled payments to pay-for-performance models.
The Benefits Of A Patient-Centered Model
The personalized support and health recommendations provided through value-based care contribute to three significant benefits for consumers, including:
- Better health outcomes and help with chronic conditions.
- Lower care costs.
- A simpler, more effective care experience.
In one recent study of critical health indicators, commercial employers with members enrolled in Anthem’s value-based arrangements had:
- 6.5% higher rates of breast cancer screening.
- 7.1% higher rates of colorectal cancer screening.
- 7.7% higher rates of well-child visits by age 2 1/2.
Patient-centered care can provide tangible benefits for employers and care providers as well. Employers often report improved employee satisfaction and reduced costs, while doctors, hospitals, and health systems likewise may see improved patient satisfaction, better health outcomes, and higher staff productivity.
Shifting The Focus
Anthem and other insurers recognize the long-term benefits of value-based care and have been investing in strategies and initiatives to support and improve each member’s healthcare journey.
In 2022, for example, Anthem launched the Oncology Medical Home Plus (OMH+) program. OMH+ leverages digital resources, population health analytics, and practice-transformation tools to incentivize patient-centered decision-making by providers and increase patients' access to affordable, quality cancer care.
Value-based care models such as this demonstrate that it is possible to achieve better health outcomes and lower costs. When providers are paid for delivering efficient, evidence-based care, everyone wins.