The shift to value-based care (VBC) in the U.S. has been slow in coming, in large part because providers have continued to cling to the traditional “fee for service” (FFS) healthcare model that historically has worked well for them (if not always for the patient). Plus, it’s how they’ve always done business.
But the inefficiencies and inflexibility of FFS were laid bare during the COVID-19 pandemic. Providers suddenly were confronted with the jarring reality that, under a fee-for-service reimbursement model, no service means no fee. Revenues plunged as patients canceled elective surgeries and clinician offices restricted hours and patient volume.
In contrast, value-based care models reimburse providers for delivering better outcomes for patients and populations while reducing costs. The emphasis is on quality care, not quantity.
Key to making VBC work are technologies that enable clinicians to personalize care plans for treating each patient’s unique health risks. Fortunately, huge gains are being made in the areas of genetic testing and precision medicine, which allow clinicians to use a patient’s genetic makeup and other molecular data in the course of providing care.
VBC is especially promising in helping providers treat patients with chronic diseases. The Centers for Disease Control and Prevention (CDC) estimates that 90% of the country’s $3.8 trillion in healthcare spending in 2019 went toward treating people with chronic and mental health conditions.