The current fee-for-service (FFS) healthcare model has been the dominant payment system. In fiscal year2022, there were 1.1 million health care providers enrolled in the Medicare FFSprogram. The trend is to transition to a value-based care model. Value-based care ties the amount that healthcare providers earn for their services to the results they deliver for their patients, such as the quality, equity, and cost of care. Through financial incentives and other methods, value-based care programs aim to hold providers more accountable for improving patient outcomes while also giving them greater flexibility to deliver the right care at the right time. CMS has expressed, in their strategic plan, thatall Medicare and a vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.
The transitioning from a volume, FFS, model to a value-basedcare model focuses on improving outcomes, reducing cost, as well as improving the patient and provider experience is centered on having a viable plan establishing a pathway to value.
The macro trends of today’s health market is that there is anolder growing aging and sicker patient population coupled with less providers and nurses available to deliver care services. There are more consumers today with chronic conditions than yesterday –diabetes, cardio, respiratory and obesity being the most consuming of financial resources – a pandemic in its own right. The average Medicare patient with five chronic conditions sees nine different providers each year coupled with only having face-to-face encounters with their entire provider team for 15 hours each year. The greater question is what happens during ther emaining 8,745 hours each year. This “time”can be defined as the “gap in care”. Patients have a provider team but there is little patient engagement in between encounters; hence care plan compliance, inclusive of medication therapy adherence, is grossly underachieved.
The pathway to value can be realized by adopting a care program that increases patient engagement while achieving the tenants of value-based care in an FFS model. This experience will establish confidence that the four tenants of value-based care, noted above, is 1) achievable and 2) more prepared to engage in a risk-oriented reimbursement model. Let’s discusscare programs that achieve said objectives:
One reads the description of each of these FFS programs and it appears to target the same outcomes as value-based care. Benefits to adopting these programs now allows providers the opportunity to realize greater practice revenue while reducing overall cost of care, improving outcomes and most importantly, enhancing the patient engagement and overall patient experiences. Engaging in these advanced FFS programs today allow the provider to gain the necessary experienceas to its overall impact so that the step to engaging in risk oriented,value-based care contracts, is not so daunting. Remote Patient Monitoring and Chronic Care Management programst oday are a clear pathway to CMS’ objectives to have all Medicare and a vast majority of Medicaid beneficiaries enroll in a care relationship with accountability for quality and total cost of care by 2030. There is no downside to acting today.