By Michael Duff and Thomas Foels
A major trend is quietly but rapidly taking hold in the U.S. health care industry and it has the potential to significantly improve patient outcomes and overall access to care, while also dramatically changing the standard payment structure used to reimburse physicians and providers. It’s called value-based care.
Value-based reimbursement rewards physicians for providing patients with evidence-based medicine while advancing safe, appropriate and effective care as opposed to the traditional volume-based, fee-for-service models that reward more – often unneeded, duplicative and in some instances potentially damaging – tests, treatments and procedures. This overutilization drives up costs unnecessarily.
Results from a national survey of providers and payers released this summer found the adoption of value-based care has “graduated from the wave of the future to the tsunami of the present,” and will dwarf volume-based, fee-for-service reimbursement models by 2020.
The rapid shift to value-based care is being driven in large part by the federal government. The Centers for Medicare and Medicaid Services (CMS) has set a timeline to tie 50 percent of Medicare payments to value-based reimbursement by the end of 2018. Because CMS is the largest health payer in the United States, this will be the sea change for the new model.
The move to value-based care is essential to improving quality and reducing the unsustainable growth trend of national health care costs, but like anything new, it isn’t an easy transition.
Western New York Urology Associates and its affiliate company, Cancer Care of Western New York, are partnering with Independent Health on a series of value-based initiatives.
These collaborative efforts, which provide enhanced reimbursement for meeting and exceeding national and local benchmarks of quality and efficiency, are working. For example, Western New York Urology and Cancer Care of Western New York’s cost-per-episode rate for prostate cancer treatment is far less than its peers while still surpassing all quality measures.
The overall goal of this reimbursement model is to improve the quality and efficiency of care in order to make the health care system work better for patients.
To achieve this, Independent Health provides its partner physicians and providers with data and insight on practice patterns and other metrics, but leaves the decisions on care between the patients and their doctor, where they belong.
Michael Duff, M.D., is a board-certified radiation oncologist at Cancer Care of Western New York and Western New York Urology. Thomas Foels, M.D., is executive vice president and chief medical officer at Independent Health.