Pros And Cons Of Value-Based Care

Value-based care models continue to attract attention, but many organizations (including multi-employer groups) feel trapped in a healthcare system built for fee-for-service care models. But there is a way out — and it’s a sustainable path with benefits for every person involved. 

Benefits of value-based care

The value in value-based care is “derived from measuring health outcomes against the cost of delivering the outcomes.” Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects of chronic disease, and live healthier lives. This improves the quality of care and strengthens the member experience.  

Value-based care also equips organizations to reduce their overall healthcare spending at a time where healthcare is often the second largest expense for an organization (after payroll) and employees pay a significant percentage of their paycheck towards premiums and medical bills account for the largest portion of American’s debt. Rather than reducing costs through high-deductible plans that create a barrier between employees and the care they need, employees receiving care from a value-based care model spend less of their hard-earned paycheck — and achieve better health outcomes. 

It’s a winning formula for organizations looking to level their balance sheets and retain top talent by providing benefits with real-world results. 

Challenges of adding value-based care

Organizations can face challenges as they consider shifting their benefits strategy to include a value-based care model. 

Here are three common barriers:

Challenge #1: The status quo

The majority of healthcare providers operate in a traditional fee-for-service world. This can create a hurdle for organizations looking to find a primary care vendor who is truly invested in value-based care.

Challenge #2: Internal infrastructure

There’s a significant lack of data sharing in traditional healthcare, and many vendors don't have the informatics and analytics to deliver population health at scale — which is foundational to improving health outcomes.

Challenge #3: Culture

It can feel a bit arduous to shift the culture of your organization if key stakeholders don’t understand the benefits of adding a value-based care plan — but it’s an obstacle that can be overcome.

If you’re feeling overwhelmed by challenges like these, partner with an expert in value-based care models.

Five ways to separate vendor promises from proven outcomes

Considering these key factors will help your organization separate the value-based winners from the well-intentioned. 

Ask a vendor if their value-based model:

1. Puts primary care at the center of the care experience. Primary care can provide 80-90 percent of patient care.
2. Reduces the cost of specialty care over time. By locating care in primary care centers and utilizing high-value, low-cost specialists only when needed, organizations can sustain a significant reduction in their overall costs.
3. Increases access to and time with the provider. When patients and providers build trusting relationships, underlying causes are identified and health goals move beyond reacting to symptoms.
4. Personalizes care for all populations. Tailoring solutions to the needs of your employees ensure members receive the right care, at the right time, and in the right setting.
5. Has proven outcomes. Value-based vendors should be ready to provide not just support but evidence and outcomes that can be presented to your organizational stakeholders.

Advanced informatics and analysis help us deliver personalized care and bridge the gap for organizations geared for fee-for-service models. Our value-based care model is nimble and adaptable, and it’s designed to meet organizations right where they are.  

Learn more about the importance of value-based care (and the best way to deliver it) by downloading our free eBook.