Question

develop a value based medical payment system that is based on what is important to the patient.

Answer 1

Ans) Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes.

- Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.

- Value-based care differs from a fee-for-service or capitated approach, in which providers are paid based on the amount of healthcare services they deliver. The “value” in value-based healthcare is derived from measuring health outcomes against the cost of delivering the outcomes.

- The benefits of a value-based healthcare system extend to patients, providers, payers, suppliers, and society as a whole.

- Value-Based Healthcare Benefits: Lower Healthcare Costs, Higher Patient Satisfaction, Reduced Risks

- Patients spend less money to achieve better health.
- Managing a chronic disease or condition like cancer, diabetes, high blood pressure, COPD, or obesity can be costly and time-consuming for patients. Value-based care models focus on helping patients recover from illnesses and injuries more quickly and avoid chronic disease in the first place. As a result, patients face fewer doctor’s visits, medical tests, and procedures, and they spend less money on prescription medication as both near-term and long-term health improve.

- Providers achieve efficiencies and greater patient satisfaction.
- While providers may need to spend more time on new, prevention-based patient services, they will spend less time on chronic disease management. Quality and patient engagement measures increase when the focus is on value instead of volume. In addition, providers are not placed at the financial risk that comes with capitated payment systems. Even for-profit providers, who can generate higher value per episode of care, stand to be rewarded under a value-based care model.

- Payers control costs and reduce risk.
- Risk is reduced by spreading it across a larger patient population. A healthier population with fewer claims translates into less drain on payers’ premium pools and investments. Value-based payment also allows payers to increase efficiency by bundling payments that cover the patient’s full care cycle, or for chronic conditions, covering periods of a year or more.

- Suppliers align prices with patient outcomes.
Suppliers benefit from being able to align their products and services with positive patient outcomes and reduced cost, an important selling proposition as national health expenditures on prescription drugs continue to rise. Many healthcare industry stakeholders are calling for manufacturers to tie the prices of drugs to their actual value to patients, a process that is likely to become easier with the growth of individualized therapies.

- Society becomes healthier while reducing overall healthcare spending.
- Less money is spent helping people manage chronic diseases and costly hospitalizations and medical emergencies. In a country where healthcare expenditures account for nearly 18% of Gross Domestic Product (GDP), value-based care has the promise to significantly reduce overall costs spent on healthcare.