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Payers and providers have long had ups and downs in their relationships, even before the Affordable Care Act. But prior authorization and data interoperability demands, coupled with patient volume and clinical documentation needs, mean payers and providers feel under more pressure than ever before.
Value-based care (VBC) offers a care model alternative to the traditional fee-for-service model, incentivizing providers to treat their patients more prospectively which can require them to take on more risk. VBC reimburses providers based on patient health outcomes and the quality of care rather than the quantity of services. But for VBC to be effective, providers need to have a holistic picture of their patients’ health, which will support better patient management and comprehensive treatment, and unfortunately doing this can also require use of multiple and disparate systems that are often a heavy administrative burden.
When VBC is effective, it spurs patients to be more active in their healthcare and improves patient adherence to treatment plans. The goal is to reduce hospital re-admissions and control escalating healthcare costs by basing reimbursement on patient outcomes. Although fee-for–service continues to dominate the healthcare industry, VBC has made inroads into the mainstream of healthcare.