| Value-based healthcare is a business model that seeks to reduce the cost of healthcare services by providing patients with the right care from the right provider at the right time. Under the traditional fee-for-service model, healthcare providers charge patients for each service that is performed. The problem with this discrete approach to billing is that it can inadvertently incentivize healthcare providers to perform too few or too many procedures. By comparison, under a value-based care model, healthcare providers are encouraged to focus attention on improving patient outcomes rather than delivering services. In this approach, physicians are financially incentivized to collaborate with each other about each patient's care to reduce gaps and overlaps in services. Options for bundling payments or alternative payment plans give healthcare providers added financial incentives to provide patients with both high-quality and cost-effective healthcare. In many ways, value-based care is at the forefront of future medical regulations and treatments. The U.S. government is using this approach to transition towards medical activities that treat the overall health of a patient rather than reacting to symptoms once a person becomes sick. One strategic way healthcare providers are able to achieve value-based care is by using data analytics to proactively identify members of a population who are at risk. For example, analytics can help healthcare providers identify which patients are not coming in for annual check-ups or haven't received immunizations. The U.S. Centers for Medicare and Medicaid Services (CMS) has initiated several value-based programs. They include: Hospital Acquired Conditions Program - encourages hospitals to reduce the number of infections or illnesses that patients receive while admitted. This program reduces payments for hospitals that rank the worst for how often patients get hospital-acquired conditions. Hospital Readmission Reduction Program - lowers payments to Inpatient Prospective Payment System hospitals that have too many readmissions. This program incentivizes hospitals to improve their communication, care coordination and how they work with patients and caregivers on post-discharge planning. Hospital Value-Based Purchasing Program - rewards acute care hospitals with incentive payments for the quality of care they provide to Medicare patients. This program is designed to improve the patient experience during hospital stays.
Value Modifier Program - measures the quality and cost of care for Medicare patients. This program determines the amount of Medicare payments physicians will receive based on their performance on certain cost and quality measures.
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