Volume to Value: Why | February 2023 | Clinical Corner

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February 1, 2023

Volume to Value - Why

 

“62% of patient respondents had never heard of value-based care, yet 59% said they would support a healthcare system where providers are paid based on the quality of work versus volume,” in a survey of 1,000 US healthcare consumers. (1) The survey reveals patients’ lack of awareness regarding value-based care.

51% of physicians indicate they are aware of the cost of the treatments and tests they order and 46% of physicians indicated they follow clinical pathways adopted at their organization. (2) The survey reveals physicians’ slow transition to value-based care.

The marketplace and payers are moving toward value – these value-based models are designed to reduce spending and improve outcomes. Research published in the New England Journal of Medicine shows that this model can help resolve the cost and quality issues that plague our current system. (3) The adaptation from volume to value is not just for the provider, this adaptation will provide value for the patient.

From the patient perspective:

  • People are beginning to take a more active role in the healthcare decisions for themselves and for their families and relatives.
  • Patients are starting to analyze and select healthcare options based on evidence, advisement, cost, complications, and outcomes.

    From the physician perspective:

  • When a provider is financially and administratively motivated to manage cost then the concept of the right service, at the right time in the right setting has a greater impact on the patient and their outcome.
  • Since fee schedules remain flat, financial models like Patient Centered Medical Home, Accountable Care Organizations, bundled payments, and gain sharing agreements provides revenue for the physician/practice to sustain financial viability.
  • With the advent of the EHR and the population health registry like Persivia, the data and analytics have expanded to assist the physician with cost and utilization performance.

    From the payer perspective:

  • By 2030, the Centers for Medicare and Medicaid Services proclaimed all Medicare fee-for-service beneficiaries will be in a care relationship with accountability for quality and total cost of care. Accountable care models will be almost universal for Medicaid beneficiaries.
  • An overall reduction in low value services, waste, and duplicative services

These value-based models challenge physicians to address individual patient and population needs over a longer period and address new priorities for their practice. The next Clinical Corner discusses the activities for success in Value-based care (to be released February 15, 2023).

 

References:

  1. Understanding the Power of Value-Based Care, Chris Klomp, PointClickCare, August 17, 2021.
  2. What needs to change in care models, compensation, and decision-making tools? Deloitte 2020 Survey of US Physicians, Mark Bethke and Randolph Gordon, MD, Deloitte Consulting LLP.
  3. Health Care Spending, Utilization, and Quality 8 years into Global Payment, Zirui Song M.D., Ph.D., July 18, 2019, The New England Journal of Medicine.