What Everyone on Medicare Should Know About ‘Value-Based Care’

This article was authored by Blake Farmer , Wellvana Head of Content, and Nikki York , VP of Care Management and Coordination.

Take a look at any itemized hospital bill, and it’s clear that patients — at least those who can pay — are incredibly valuable to the health care system. Check out any installment of KHN’s Bill of the Month series.??

But how valuable is a patient’s health???

“Healthcare is no longer about healing. It is about keeping patients alive by treating them as much as we can and as often as we can,” says Wellvana co-founder and former hospital entrepreneur Charlie Martin.??

His one-time colleague and fellow healthcare investor, the late Clayton McWhorter, shared Martin’s souring view on fee-for-service medicine.?

“I sort of believe we have a system that we don't want you to get well nor die, because either way we lose a customer," McWhorter said near the end of his life.?

Said less brazenly, our healthcare system was not designed for health. Wellvana is designed to change that.??

Change comes by way of #valuebasedcare — a term that means very little to most patients (and even some physicians). Put simply, it’s quality over quantity. And that shift to prioritizing high-value care may feel different and even unsettling. But it can go a long way if Medicare patients understand why they’re being asked to do things differently.??

Here’s what to expect.?

Your doctor will push harder to see you every year, even when you’re not sick. They’re not trying to squeeze an extra co-pay out of you or order a battery of unnecessary tests to bill you for (in fact, there should be no cost). Value-based care focuses on prevention rather than treating sickness. That means seeing the doctor for an annual wellness visit.??

Think of your primary care provider as the quarterback of “Team Healthy You.” You may have a specialist managing your heart disease and another specialist managing your COPD, but your doctor still needs to be aware of all the health care you’re receiving to tie it all together and reduce redundancies.?

Expect more support from an experienced care team. Doctors transitioning to value-based care, at least those aligned with Wellvana, rely on remote nurses who create a relationship with patients. They can coordinate scheduling an annual wellness exam, but they also provide extra attention for patients who have multiple chronic conditions. Care managers also focus on patients who’ve been to the ER several times in a short period or are recently discharged from a hospital stay. Their job is to help you navigate the system and stay well. When needed, they’ve even arranged rides to the doctor. The service doesn’t cost you anything — in fact, it should help reduce costs for everyone involved — so take advantage.??

Data drives decisions, and that’s a good thing. In the past, doctors had to rely solely on their training and experience to make complex decisions about a patient’s care. Now they can connect the dots using large databases and a patient’s individual medical record, helping doctors essentially predict who may need a more personalized approach. The data allows them to be more proactive and double down on prevention.?

The incentive is to keep you well, which keeps costs low for everyone. Healthcare isn't free with #medicare. You still must be wary of co-pays and deductibles. But in these value-based arrangements, doctors are rewarded for keeping patients well and out of the hospital — where out-of-pocket expenses add up quickly. That means asking patients to call their doctor or care manager before going to the ER. They’re not trying to set up a blockade between you and high-level care. They just may be able to see you quicker than the ER can. And they know the ER will likely leave you with a hefty bill.??

There will be a test (a survey actually). Feedback is critical to delivering more valuable care. Patients with a value-based provider can expect at least two surveys a year from the federal government. And your doctor’s all-important Medicare Care Compare star rating is largely based on this feedback. So answer honestly and know that it will make a difference.?

Value-based care doesn’t have to be complicated. It’s local doctors practicing medicine the way they always wanted to, focused on keeping patients healthy rather than seeing them only when they’re sick. When it works as intended, value-based care should save money for you as a patient and a taxpayer and help restore trust in the U.S. healthcare system.?

Learn more: https://wellvana.com/patient/