Understanding value-based care

Doctors have traditionally been paid for the number of services they perform during a patient visit. This model, known as fee for service, may not take into consideration the outcomes of those services for the patient, focusing instead on volume instead of quality, potentially resulting in higher costs and worse outcomes.

Dr. Jessica Bartell, executive vice president and chief medical officer of population health and value-based care for UnitedHealthcare, answers a few questions about value-based care, and what it could mean for helping to transform the health care system. 

At its heart, value-based care is a health care delivery model where health care professionals — hospitals, labs, doctors, nurses and others — are paid based on the outcomes and quality of the care provided to patients instead of the number of services the patient received. Because value-based care puts the emphasis on patient experience and outcomes, as well as on health care access and coordination, health care professionals can focus on the overall health of the patient. Are they getting their preventive screenings such as mammograms and colonoscopies? Are they taking their medications?

A few of the benefits patients may see are impactful health care support such as care management, support for health-related social needs and coordination of care if they have multiple conditions and therefore see several doctors. Value-based care promotes a team approach. Many times, patients who have their specific care needs supported through a team-based approach involving doctors, nurses, social workers, health coaches and others may experience better quality care at lower cost and better health care experiences. For example, involving a facility’s pharmacy team to make sure patients are taking their medication when and as prescribed — something known as medication adherence — may improve the overall care the patient is receiving.

Perhaps one of the greatest benefits for health care professionals — other than the financial incentives — is that practicing in a value-based care environment may allow them to focus on delivering care and spending time with their patients instead of trying to see as many patients as possible during their office hours because they are rewarded for better patient outcomes instead of patient volume. They also may experience less administrative burden and we believe improved quality and experience for their patients. Additionally, as health care professionals grow more comfortable with value-based care, they may be able to take on greater responsibility — which can mean greater financial rewards — for managing the quality and cost of care they provide.

I believe health disparities, excess expense, inadequate access, waste and administrative complexity are some of the issues currently facing the health care system. At its core, value-based care provides financial incentives to reward health care professionals for proactive management of preventive care, chronic conditions and health risks. As a result of this, health care professionals can spend time with their patients, focusing on the individual care of each patient. For example, do they have patients who are facing food insecurity and perhaps they don’t have a place to live or consistent transportation to get care? These “social determinants of health” can impact the overall health of patients. Value-based care arrangements help give health care professionals more time and opportunity to understand what their patient needs may be — from a health and social perspective and perhaps offer services such as care coordination, wellness and behavioral health programs or access to community support programs — all of which can help improve a patient’s health. 

The keys to help build success in value-based care oftentimes are activities focused on the basics of population health management — looking at the health of an entire community, rather than just at individuals one by one as they seek care.

These efforts, which can help drive improvements in cost, quality and experience, include improving access and avoiding expensive downstream costs and complications — such as readmissions and avoidable hospitalizations and excess emergency department use. This can also help identify high-risk patients, improve management of social determinants of health and close care gaps.