A healthcare facility’s revenue is tied to its patient reimbursement model. Any shift you make in the reimbursement process can have a significant impact on your financial health.

Providers are now looking into a new healthcare reimbursement model that can streamline healthcare and cut costs called value-based care. This model is based on the quality of care rather than quantity. In other words, your facility gets rewarded for providing quality care to patients, which means better patient care while lowering costs and improving cash flow.

With over 100+ years of combined experience, Coronis Health is well versed in sliding scale and other payment models. We design our medical billing services and revenue cycle management services specifically for facilities to optimize their revenue cycle and increase cash flow. We identify and capture missed revenue or find new revenue streams. Our goal is to implement the appropriate systems into your workflow so you can enjoy a healthy bottom line.

Value-Based Care vs. Fee-for-Service

Under the traditional fee-for-service model, healthcare providers invoice for each service or procedure they perform. Instead of bundling, the patient pays for services separately. This system incentivizes providers to complete as many services as possible to bring in more revenue.

Under the value-based care model, healthcare providers receive compensation based upon patient health outcomes, encouraging them to deliver quality care. In a value-based reimbursement model, effectively managing an individual’s and population’s health generates revenue. Visit ncbi.gov for more information on value-based care.

Many organizations have already embraced a value-based care system as one of the most efficient methods for lowering healthcare costs while increasing quality care and ultimately helping communities lead healthier lives.

Benefits of Value-Based Care

This new care delivery and payment system provides such benefits for facilities and patients alike as:

• Patients spend less money without compromising health: Since value-based care is focused on quality, patients don’t have to pay for services they don’t need. Furthermore, the model focuses on establishing solutions agreed upon between patient and provider, resulting in patients recovering from illnesses more quickly or avoiding them in the first place. This means fewer tests, procedures, and doctor’s visits, resulting in spending less money while improving health.
• Greater efficiency and patient satisfaction: To improve the quality of care, providers focus on developing medical solutions and prevention-based services and fostering better relationships with patients. All these strategic changes can contribute to increased patient satisfaction. 
• Lower costs and reduced risk: Value-based care lowers costs. Insurers have to pay less money for services that their clients use, making insurers less likely to raise deductibles and premiums. Furthermore, value-based payments encourage efficiency by allowing payers to use a bundled payment system that covers all a patient’s care.
• Prices will match value: Supply and demand determine physician services and prescription pricing. A value-care model may contribute to price changes that reflect the value that services and medications give patients. By focusing on the patient rather than the number of services provided, it becomes easier for manufacturers to align their products’ prices to the value they offer.
• Healthier society: Value-based care aims to help make your community healthier. By focusing efforts on providing efficient treatments and preventing illnesses, patients and insurers spend less money on disease management, emergencies, and hospitalizations. This means fewer chronic conditions as well. The healthier society is as a whole, the less money all parties have to spend on healthcare.

Value-Based Care Models Your Facility Can Use 

Since different payment structures enable facilities to measure value in various ways, providers may use other methods to implement them based on their or the payers’ needs. Examples of models include:

• Accountable Care Organizations (ACOs): In this care delivery model, hospitals, doctors, and other healthcare providers work together to deliver quality care to patients. This model relies on the networked team’s cooperation. When healthcare providers collaborate, stay accountable to providing high-quality care, and agree on the patients’ treatment plans, they avoid redundancy and excess services. 
• Bundled payments: Healthcare providers collectively receive payment for the costs of treating a specific condition, which may cover several procedures and physicians. But the bundled payments system is more than just grouping together a list of services. By paying for value rather than volume of care, bundled payments provide a better level of care by establishing a structure that appoints providers as clinical leaders while keeping risk manageable.
• Patient-centered medical homes: This care delivery model focuses on centralizing patient care through a primary care physician. Like ACOs, this model requires providers to work as a team to create holistic care settings conducive to catering to patient needs. Using electronic medical records (EMRs) is one great way to collaborate. EMRs provide easy access to patient information, allowing providers to retrieve procedure results quickly. By sharing information, providers get to avoid redundancy and its associated costs.

How Value-Based Care Can Create Success for Your Facility

Transitioning from volume to value takes on a more proactive and preventative approach to patient care. Employing a value-based care system will likely encourage you to build on data, technology, and collaborative efforts. In effect, you’ll develop a more integrated approach for managing people’s wellness instead of treating illness as it occurs.

The new models incentivize healthcare providers to engage patients, use data analytics, and upgrade health technologies and software, which all aid in improving the quality of care. Because when patients receive appropriate, effective, and coordinated care, they also reap the benefits. By improving your revenue cycle management strategies, you get to reduce cost-to-collect, increase cash flow, and ensure maximized collections with fewer denials.

Shift to Value-Based Care with Help from Our Medical Billing Services

Value-based care is a relatively new concept for most healthcare providers. You will need to refocus your revenue cycle management system to include population health management, more efficient billing and coding techniques, and more data analytics tools. Outsourcing may be your best solution to improving your current system with value-based care in mind. To learn more about our medical billing services, contact Coronis Health to request your free financial check-up.