What Value Based Care Means
Healthcare has been shifting away from the “fee-for-service” model, and Medicare is at the center of that transformation. Traditionally, doctors and hospitals were paid based on the number of tests, procedures, or visits they provided, regardless of whether patients got healthier. What Value Based Care means is a little different. VBC rewards providers for improving patient health and keeping costs down.
The Basics of Value Based Care
Value Based Care is about quality over quantity. Instead of simply paying for services rendered, Medicare ties payments to outcomes such as:
- Better health results – like reduced hospital readmissions or better management of chronic diseases.
- Improved patient experience – including communication, accessibility, and overall satisfaction.
- Lower overall costs – through preventive care, care coordination, and reduced unnecessary treatments.
How Medicare Uses Value-Based Care
Medicare has introduced several programs and models to encourage providers to embrace VBC. Some of the key examples include:
- Accountable Care Organizations (ACOs): Groups of doctors, hospitals, and other providers who work together to give coordinated, high-quality care to Medicare patients. If they save money while meeting quality goals, they share in those savings.
- Bundled Payments for Care Improvement (BPCI): Instead of billing separately for every service, providers receive a single payment for an entire episode of care, like a hip replacement or heart surgery.
- Hospital Readmissions Reduction Program (HRRP): Hospitals receive rewards for keeping patients healthier after discharge and avoiding costly readmissions.
- Medicare Advantage Plans (MA): Many MA plans already use value-based arrangements with providers to improve preventive care and manage chronic conditions.
If you are ready to join Crowe team; click here for online contracting
Why Value-Based Care Matters
For Medicare beneficiaries, Value-Based Care means:
- More preventive services: Encouragement to get screenings, vaccines, and wellness visits.
- Better coordinated care: Doctors and specialists share information to avoid duplication and gaps.
- Healthier outcomes: The focus is on managing conditions and preventing complications, not just treating problems when they arise.
For the healthcare system overall, VBC helps reduce wasteful spending and ensures taxpayer dollars are used more effectively.
Watch a YouTube video on SEP changes for Dual, Partial Dual & LIS members
The Future of Value-Based Care
Medicare’s long-term goal is to have most of its payments tied to value instead of volume. This means more providers will be incentivized to deliver patient-centered care that is proactive, efficient, and focused on health rather than procedures.
Value-Based Care is Medicare’s way of rewarding healthcare providers for keeping patients healthier, not just for doing more. As this model continues to grow, beneficiaries can expect better care coordination, more preventive services, and a stronger focus on long-term health.