Value-Based Payments as an Emerging Trend in Healthcare

You may have forgotten about it, but one of the big topics discussed during the run up to passage of the Affordable Care Act back in 2010 was changing the way payers reimburse service providers. Lawmakers wanted to see the end of the fee-for-service model in favor of outcome-based payments. Enter the value-based payment (VBP) model now emerging in healthcare.

VBPs are not even close to being the norm now, either in behavioral health or healthcare in general. But they are an emerging trend. With each passing day, more health systems, individual providers, and behavioral health management companies like Horizon Health are recognizing the value of concentrating on outcomes rather than service volumes.

Quality Is the Focus

It should be obvious that the VBP model puts a heavy emphasis on quality over volume. Quality is the entire focus in VBPs. By doing away with the fee-for-service model, VBPs encourage individual providers and health systems to prioritize prevention, monitoring, and patient satisfaction.

Though it sounds crazy, the VBP approach works best when healthcare is viewed more from the business side of things. A business perspective sees patients as customers in need of quality services. The better the services provided, the more satisfied its customers are. By focusing on better outcomes, we ultimately save money by reducing the need for so many follow up services.

Performance Metrics Are Necessary

The uncomfortable part of the VBP model is the performance metrics necessary to make it work. In other words, providers need to be measured and rated in some way that indicates the quality of their outcomes. Things can get tricky depending on the type of care provided.

In a surgical scenario, quality is measured easily enough by monitoring the patient’s health and recovery over time. Successful surgery is easy enough to document. But what about a mental health scenario? Determining what constitutes a successful treatment is a lot more subjective.

Nonetheless, performance metrics are unavoidable. In order to transform the payment system from volume to outcome quality, there needs to be a way to measure said quality. The only way to do that is to establish metrics that can somehow quantify results.

Encouraging More Care Coordination

There is a positive side to performance metrics: they encourage more care coordination among multiple providers. Improved coordination is one of the fringe benefits of the VBP model.

It turns out we are already moving in that direction with the modern emphasis on care teams. We see the care team concept across healthcare – even in the behavioral health arena. Care teams consist of a variety of clinicians, support staff, and advocates who all work together in a collaborative effort designed to benefit the patient first.

Better Data Will Mean Better Outcomes

It is important to understand that the success of the VBP model rests in data. The model is highly data driven in everything from performance metrics to patient satisfaction. So to maximize both value and outcomes, we need better data. Not only that, but we also need more of it.

As things currently stand, we lack the data necessary to maximize VBPs benefits. But as more organizations embrace VBP, they are also producing more data. All that data is being compiled, stored, and analyzed. Over time, it will lead to both better outcomes and more efficient payments.

We are closer to an outcome-based healthcare system now than we were when the ACA was first passed. Yet we still have a long way to go. The VBP model is a big step in that direction. Its time has come, especially in the behavioral health field.