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Perspectives

Value-based care

Winning the shift from volume to value

Value-based payment models have the potential to upend traditional patient care and business models. What can your organization do to effectively make the shift and “win” in the new value-based care (VBC) payment landscape?

Winning the value-based care market shift

The payment landscape is shifting under the US health care industry. With the volume-to-value transformation put in place by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), traditional fee-for-service payments are being replaced with a financial incentive framework that rewards for improved quality, outcomes, and costs. This shift to value-based reimbursement models creates a new paradigm in which care is delivered by an entire coordinated care community sharing in the responsibility—and risk—of outcomes and costs, touching almost every part of the health care delivery operations. While the law directly impacts only Medicare payments today, it lays the groundwork and provides strong incentives for other payers to move in the same direction, thus potentially disrupting the health care system at all levels.

Ultimately, value-based payments transform traditional business models by putting significant revenue– and risk– at stake. Building the outcomes-based financial models and data infrastructure to maximize value-based care (VBC) reimbursement pathways will be fundamental to sustainable growth in the future. The health care players left standing strong will likely be the ones that strategically embrace change starting now to understand the impact of MACRA and the new value-based payment models to their organizations and customize the broad array of value-focused shared saving, shared risk and bundled payment models that will work for their individual situations and populations.

With accountability and risk more broadly shared across the care continuum, VBC challenges health care providers, health systems, and health payers to change their traditional role in the health care ecosystem. Key to winning the volume-to-value shift will likely be business integration and data aggregation: inside and outside an organization, across sectors and across models of care. Health care organizations should dramatically transform coordinated care models, improve physician engagement and alignment, and build the technology infrastructure for sophisticated data analytics and financial modeling to effectively manage the new clinical and financial risks.

The level of dollar investment in VBC is substantial, yet the market shift toward VBC presents unprecedented opportunities – as well as challenges for the US health care system. What can your organization do to effectively make the shift?

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Read more about the journey to move from volume to value: Health care outlook for 2019

Value based care

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