Don't Be Late to the Party: Importance of Adopting a Value-Based Care Model

Published in Member Communities on April 04, 2023

By Boone Lockard, Director, VGM Respiratory

Value-based care is a popular term in the HME industry, especially in recent years. As the industry shifts towards a more value-based approach, it’s important for providers to understand its significance and why they should start to incorporate value-based care programs into their business sooner rather than later.

What is Value-Based Care?

The value-based care model is a healthcare delivery approach that emphasizes achieving optimal health outcomes for patients at a lower cost. Rather than focusing solely on the volume of care provided, value-based care prioritizes patient outcomes and quality of care while also trying to control costs.

Under a value-based care model, healthcare providers are incentivized to deliver high-quality care that leads to positive health outcomes, improves patient health, reduces readmissions costs, and ultimately lowers healthcare costs. This model aims to shift away from a short-term focus on payment methods to a more long-term model that generates substantial savings and also improves quality.

Currently, we see that many DME providers are trying to adopt a value-based care model into their businesses, whether it be by implementing clinical sessions, providing a plan of care goals to their patients, etc. The key to this, however, is to capture the data that is being collected and utilize it in a tool or platform to demonstrate the effectiveness of their programs. Being able to go to payers and physicians with this data to show what these programs are actually doing for their patients and how they are improving metrics is huge.

We are also seeing that while providers are supplying the equipment, doing the setup, providing education regarding that setup, and so on, they're really focused on compliance. However, under a value-based care model, it is important to think of the patient as a whole, in regard to their overall condition or disease state, rather than just providing a piece of equipment or a fee-for-service type model. Aim to manage patients, not just the compliance aspect.

Value-Based is Here to Stay

The shift towards a value-based care model has gained momentum across the country, with many healthcare providers and organizations adopting this approach to healthcare delivery. The Centers for Medicare & Medicaid Services (CMS) has proposed that by 2030, 100% of their patients will be moved over to a value or outcomes-based reimbursement structure. The idea of this is for CMS to move away from a short-term focus on payment methods to a more long-term model that generates substantial savings and also improves quality.

DME providers should start considering how to shift their current structure to reflect a more value-based care model. Providers that have already adopted this model will likely stand out to payers and referral sources over a provider still utilizing a fee-for-service model.

Programs to Deliver Outcomes

There are a number of programs and services in the industry that can help providers start moving towards a value-based model that can also help capture more referrals and patients in the long run.

There are certain programs out there that take the care plans and models, along with the metrics and data gathered, and provide them into a deliverable software platform, making it easy to deliver those outcomes and data to physicians and payer sources.

While the direct impact on revenue may not be immediate, there could be potential cost savings for providers in the long term as value-based care models focus on reducing hospital readmissions and improving patient outcomes, which can ultimately result in lower costs. Additionally, providers may be eligible for incentives or bonuses for meeting certain quality metrics or outcomes, which can also positively impact their revenue. Plus, providers are more likely to win over referral sources or providers with a value-based care model.

Overall, the shift towards value-based care can have long term benefits for both patients and providers.

TAGS