7 Things You Need to Know About Value-Based Care
Whether you love it, hate it, or still don't completely understand it, value-based care is here to stay. We've put together a brief explainer to clarify the what, how, and why of value-based care. (For a more in-depth discussion, check out APTA's podcast series.)
- Value = Health outcomes achieved / Dollars spent. Changing the payment paradigm from volume to value forces greater efficiency in the health care system; that is, delivery of the highest quality of care, and the best outcomes, at a controlled cost. Implementing a payment structure that examines outcomes and cost also will drive better-informed decisions by the patient, the payer, and the clinician.
- Value-based care is NOT fee-for-service. Value-based care shifts from payment solely based on the volume of care, such as traditional fee-for-service, to payment more closely related to outcomes of care. Value-based payment models use measures of quality and cost to determine payment to providers. These models also can be referred to as alternative payment models, or APMs.
- It's all about collaboration. APMs incentivize collaboration among members of the health care team to achieve high-quality, cost-effective care.
- Value-based care is not just for Medicare patients. Although 1 of the models PTs may be most familiar with is the Medicare comprehensive care for joint replacement (CJR) model, it is not the only model out there. There is a desire by all payers to move in this direction.
- Data collection is critical to success. To complete the value equation, outcomes must be quantified through the use of patient-reported outcomes measures or performance-based measures. This is 1 reason the Physical Therapy Outcomes Registry is so important—it will allow much broader data collection than any 1 EHR product.
- PTs should consider getting involved sooner rather than later. You will need to understand your practice and the patients you serve to decide when to participate in an APM and which model might work best. It could be a condition- or disease-specific model, such as joint replacement bundled care, or it may be population-based, such as an accountable care organization. Opportunities also may arise with specific payers.
- The details matter. No 2 APMs are the same. If you decide to participate in an APM, you will need to contract with the model organizer (or convener). Contracting is a critically important step, because you will have to negotiate the amount of risk you are willing to take on the possible financial reward you could achieve.
Want to learn more? Listen to the full podcast series. You also can check out "Quality Measures That PTs Can Impact" on the APTA website.