Value-Based Payments: How Physicians Are AdaptingTo succeed within value-based payment models, primary care physicians (PCPs) must change the way they manage not only their patients but also their practices.
Because value-based payment models take complete episodes of care into account as opposed to discrete services, collaboration is key. PCPs are at the heart of this collaboration—they must act as coordinators of care to ensure their patients have the best health outcomes possible.
The traditional fee-for-service (FFS) model made hiring medical assistants a generally cost-effective option for primary care offices, as they allowed physicians to increase the number of services provided and patients seen. However, the coordination of care that is so crucial to the value-based concept demands diverse, specialized skills. Primary care practices will benefit from having multiple specific skill sets within their practices, such as specialists, nurses, pharmacy support staff, and care managers. The financial risk that PCPs assume in value-based payment models might make them reluctant to hire such professionals because they are obviously more expensive to employ. However, they are vital to ensuring that patients receive the comprehensive care they need throughout each health episode and maintaining the volume of services and patients they support.
The downside risk in value-based payment models is daunting, especially to physicians accustomed to the thin margins associated with FFS reimbursement. Building a varied, highly skilled staff is a significant expenditure, and as such, comes with risk. That said, the flexibility in value-based payments should be seen as a boon to any physician struggling to help patients beyond the confines of their office walls. Instead of being confined to a select set of payment codes (and treatments and locations) associated with a payer’s fee schedule, physicians are free to invest in ways they know will benefit their patients.
Something as simple as returning a patient’s phone call quickly can prevent an emergency room visit. Conferring with specialists about the condition of a patient can improve that patient’s health outcome. Integrating behavioral healthcare into the case management of patients with both mental and physical health challenges is proven to improve health outcomes. As the care provided to each patient becomes more cohesive—preventing avoidable incidents and improving their overall health—the cost of care will decrease.
By embracing the flexibility to give the care that is needed, as opposed to the services that are reimbursable, PCPs who adopt the value-based payment system can lead the charge to achieve the goals of better healthcare for individuals, increased population health, and lower costs.
It’s Not Just Risk: Why the Shift to Value-Based Payment is also about Provider Flexibility (Center for Health Care Strategies)
Value-based care requires payer and provider collaboration (Healthcare Finance)
Financial Risk Sharing in Healthcare Improves Quality, Costs in CA (RevCycle Intelligence)
How Value-based Care Changes the Provider Staffing Model (Managed Healthcare Executive)
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