Value-based care is a healthcare model in which providers, including hospitals and physicians, are reimbursed based on patient health outcomes. Within value-based care agreements, providers are incentivized to help patients improve their health, lower the impact and incidence of chronic disease, and lead healthier lives.
There is currently a major emphasis by both governmental (Medicare and Medicaid) and commercial health plans to incorporate value-based care provisions into their contracts with physicians and hospitals. There are many forms that these provisions can take. These include:
Many value-based care contract provisions relate to services provided by primary care physicians, including screenings for common conditions or diseases, such as diabetes, cancer, heart disease, and osteoporosis. Other value-based provisions cover specialty physician and facility services, such as prescribing specific medications for heart disease, reducing surgical wound infections, and lowering readmissions within 30 days.
As governmental and commercial payers seek ways to incorporate value-based care into their healthcare models, providers are looking for strategies to restructure physician productivity with an emphasis on performance-based payments.
"With patient satisfaction having a tremendous impact on the reimbursement rates in the new value-based care model, access to care is a critical metric for productivity. We find that more healthcare systems need to restructure their contracts to focus on a combination of productivity goals, like RVUs, patient satisfaction, and access to care." - Cathryn Connolley, MHA, managing partner at SystemCare Health
RVU Wallet is an iOS app that can better calculate physician productivity and performance for a higher reimbursement rate and more accurate recording.
Most governmental and commercial value-based care provisions feature broad-based quality-of-care measures, which include evidence-based medicine standards to screen for common conditions and treat chronic diseases. These provisions often call for providers to receive extra payments for achieving high compliance and/or significant improvement in performing prescribed screening and treatment protocols.
Some governmental and commercial plans allow providers who meet and/or exceed their quality of care targets to share in the surplus or savings against projected costs achieved by the plans. Identifying problems early and treating them with the most effective care has demonstrated that it produces superior outcomes and lower costs.
Currently, there are relatively few provider contract provisions specifically designed to improve care for bariatric surgery services. However, a notable exception is contract arrangements developed by BARInet PPO. BARInet delivers a network of vetted, high-quality bariatric surgeons and programs across the country to large employers who want to add bariatric coverage to their existing insurance plan and provider network. BARInet emphasizes the provision of a full continuum of services to assure patients get the care they need, when they need it, by qualified professionals at facilities meeting established quality standards.
At Bariatric Centers of America, we also emphasize the importance of the bariatric care pathway through our digital health tools. Our patient navigation tool helps bariatric programs monitor the patient’s progress through care visits while ensuring they meet the requirements to receive surgery.
All this being said, there is a great benefit to be realized by bariatric surgery patients from value-based contract provisions. This is because bariatric surgery patients commonly have many conditions covered by standard value-based care provisions. Some examples of this are metrics for screening and treating hypertension, hyperlipidemia, and diabetes.
When bariatric patients have these conditions identified and treated effectively, they have improved health status and a lower risk of adverse events. In addition, patients have a lower risk of surgical complications and are more likely to recover faster and more smoothly. Other examples of value-based care programs that benefit bariatric patients are those that incentivize physicians and hospitals to achieve lower surgical site infection rates and readmissions within 30 days.
Thus, while there are relatively few value-based care initiatives specifically focused on the bariatric surgery patient population, a substantial portion of the governmental and commercial value-based care programs cover conditions common in the bariatric patient population and incentivize surgical and treatment outcomes beneficial to this population.
