VALUE-BASED CARE AND RCM

“Practicing value-based care works to address the nation’s chronic disease epidemic by giving physicians the support and data they need to focus more on prevention and reduce acute care episodes,” Roy A. Beveridge, MD, Humana’s chief medical officer, said in a statement. “This model allows physicians to focus time and energy on those patients who need the most support to stay well at home, and out of the hospital.”

The above statement is an excerpt of news highlighting how health insurance and managed care company, Humana is noticing a considerable improvement in its Medicare Advantage member’s care and health with the implementation of value-based care.

2018 was abuzz with the particular phrase “value-based care,” with some healthcare practice’s dismissing it as an overwhelming and loss-incurring process. On the other hand, news channels are broadcasting how it is driving the healthcare facility’s qualitative service while keeping the cost in check.

Let us discuss this deemed as a “revolutionary” form of healthcare practice, value based-care in detail:

So, what is value based-care?

It is a reimbursement payment methodology which is challenging the traditional fee-for-service scheme, with the ambition to focus more on quality care at a reasonable cost rather than only focusing on volume-based care, which was the provision up until now.

What is all the fixation about?

The prime focus in value-based care is on health outcomes and not on the cost of delivering the service, which was the approach in fee-for-service methodology.

How is value-based care and fee-for-service different in practicality?

With the fee-for-service model, the healthcare facilities are compensated for the number of services they provided and the procedures they performed on the patient, by insurance companies and government-affiliated organizations. This means for every visit, every procedure performed, the practice would be paid by these third-party payers, without checking whether or not the procedures were required or just performed for adding to the billing.
But with value based-care, the clinics and physicians are reimbursed for the quality of service they provided with cost-efficient means. Unlike the fee-for-service, value-based care model follows a comprehensive approach to make sure that the physicians are rewarded for the quality of treatment they dispense to the patient at a lower cost.

What benefits can value-based care offer?

Managed care organization, Humana and reputed U.S Health and Human Services department, Centre for Medicare and Medicaid are examples of how value-based care is delivering positive results. Let us have a look at benefits that implementation of value-based care can offer:

~As for now, value-based care is concentrated on chronic disease treatment in the United States. Since the primary goal of value-based care is to enhance the treatment patients suffering from this chronic disease get at lower cost. This results in patients visiting the facility less and spending less money on prescription medication, lab tests, procedures, etc. Better health can be made possible at a reasonable cost.

~With value-based care, payment based risks can get considerably mitigated, from decreasing claim denials. It facilitates a comprehensive payment plan for holistic treatment. This way the payer would be able to control cost and reduce the risks.

~The prime focus of value-based care model is quality and patient engagement, which moves the financial risk from the provider and helps to ensure greater patient satisfaction while reducing overall healthcare spending.

Yes, shifting from the conventional fee-for-service to fee-for-value might take significant time in being implemented on a wide span, but this methodology will ensure quality treatment to patients across the world at considerably lower costs.

Since value-based care is a relatively new service, the healthcare service provider must not risk their finances by letting their in-house team handle it. An intricate process like this needs exhaustive knowledge and expertise of a professional billing and coding service provider like Medphine. We have a team of certified and experienced medical billers and coders that will make sure that every strategy implemented in your revenue management cycle as per the standards laid down by the medical and federal board.

Outsourcing ensures saving time and money, wasted on trying to perform difficult calculation and complying with strict rules. You can trust upon Medphine’s expert in streamlining you healthcare’s facility’s revenue cycle with cost-effective means, ensuring faster reimbursements with 98% claims payment on the first submission.

Contact Medphine’s team of specialty-specific medical billers and coders, today and see your healthcare practice’s revenue grow exponentially.