Value-Based Care versus Fee-for-Service: The Gap between Theory and Reality and the Importance of Embracing Innovation

Value-based care (VBC) is a term used in the healthcare industry, which aims to reduce patient costs while improving their health outcomes. The equation for VBC is "Value = Quality/Cost." The US federal government supports this initiative with Medicare advantage, accountable care organizations, and bundled payment models, while other countries such as Canada are closely watching and implementing billing codes for Remote Monitoring (RPM). However, implementing VBC can be challenging in reality, with patients sometimes facing early discharges, limited access to care and specialists, and decreased patient satisfaction.

One of the major costs of VBC is the management of acute patients staying in hospitals, which can lead to decreased patient satisfaction due to early discharges and rushed transfers. Avoiding specialist care in VBC also leads to increased complaints due to delays in getting referrals approved and limited choices for patients.

Value-based care groups also broaden their clinician teams with complementary staff, but this can create confusion among patients and sometimes result in poor outcomes and coordination. Furthermore, VBC groups tend to be conservative in their spending on innovation, which can conflict with patients who are knowledgeable about the latest technologies and drugs available on the market.

In conclusion, the main takeaway is that value-based care entities should prioritize the benefits to patients over financial gains. Healthcare organizations often focus on optimizing their budget instead of optimizing care for patients, but there should be a balance between over-delivering and under-delivering care. Prioritizing patient care not only improves the quality of care but also creates more opportunities for healthcare entities using a value-based care approach. As more companies in the US and Canada move towards value-based care to curtail costs, there is a need for innovation from VBC stakeholders.

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