The healthcare industry is already facing limitations of reliance on fee-for-service reimbursement and COVID-19 pandemic exposed it badly. Hence to overcome limitations of fee-for-service model, Value-based care model has emerged.
Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. You can find various value-based care models, such as the Medicare Shared Savings Program and Pioneer Accountable Care Organization (ACO) which transform how healthcare providers are reimbursed for services rendered.
President-elect Joe Biden is known for his advocacy of the Affordable Care Act (ACA) that began the initial push toward fee-for-value. But does value-based care have any significance in 2021? Let’s talk about value-based Care in 2021 in more details.
Need for providers to lean into value-based care
During the COVID-19 pandemic, heavy investment from providers in value-based care are getting consistent source of revenue despite low utilization. Dynamic regulatory changes and innovations in care delivery offers various revenue opportunities for providers by increasing the portion of their business with value-based care reimbursement. Moreover, the continuous changes in health care which are mainly driven by the pandemic are emphasizing more on the need for providers to lean into value-based care.
Scope for innovation and disruption
Commercial payers are pushing towards innovative payment and care models as COVID-19 has highlighted the inequities in the healthcare delivery system and challenges for providers. Moreover, The Biden administration’s health care goals are focused on cost savings with quality care. This is fueling the adoption of value-based care. Hence you can observe that there is a drive from government and private players to innovate various care delivery models as well as payment systems due to Covid-19.
Telemedicine and other digital health model
Providers are offering their services via telemedicine and other digital health care model during the COVID-19 public health emergency.
According to research published in Health Affairs, Early in the COVID-19 pandemic telehealth visits accounted for approximately 30% of total outpatient visits and uptake varying among specialties and by patient characteristics.
Providers opting a way for digital health in the pandemic will have the opportunity to capitalize on this investment as a way to manage patient care and look for RoI for services that are typically not reimbursable under fee-for-service arrangements. Moreover, many of the telehealth waivers have been made permanent.
Some programs like Hospital without Walls, Acute Hospital Care at Home etc. which are created by CMS to improve hospital capacity during pandemic.
Providers who invested in these programs provide an opportunity for quality care in lower cost environments which will benefit fully engaged in value-based care providers.
Government initiatives for value-based arrangements
US government is now focusing on value-based care by making some changes in federal law to lower barriers to value-based care. The Stark law and Anti-kickback Statute created by CMS and the Office of Inspector General (“OIG”) for value-based arrangements; allow providers to enter into value-based care arrangements that previously may have been prohibited.
Moreover, patients and providers are able to access health information, further reducing structural barriers to value-based care with the sweeping interoperability and information blocking rules.
For most healthcare providers value-based care is still a new concept and many are still trying to implement the appropriate systems into their workflow. The transition from fee-for-service to pay-for-value is the greatest financial challenges the U.S. healthcare system currently facing. Are you ready for this change? We are expert Medical billing and coding professionals and help you to grow your revenue. If you’re ready to get started, schedule a meeting with our medical billing manager from filling out enquiry form from our website!