Preventative care. Patient-centered care. Care coordination. Patient outcomes.
Quite fancy terms, aren’t they? They seem really important, too. All of these terms are part of the value-based care system. But what exactly do they mean?
On that note, what does ‘value-based care’ itself mean?
The meaning of value-based care
The Centers for Medicare and Medicaid Services (CMS) define value-based care as a healthcare delivery system that is “designed to focus on quality of care, provider performance, and the patient experience. The ‘value’ in value-based care refers to what an individual values most.”
Sounds great! But again, what does that mean in everyday language?
Understanding the real value in value-based care
Let’s revisit that last sentence in CMS’s definition: “The ‘value’ in value-based care refers to what an individual values most.”
What do you value the most when it comes to your healthcare? As a general rule, most of us value
- Feeling well and not having pain or discomfort.
- Staying out of the hospital emergency room.
- Not wiping out our lifesavings to pay for a medical procedure that is sudden, advanced, and could well have been avoided with preventative care.
But when you start getting into the specifics, you find that priorities may not be the same for everyone. Also, what you value as a desirable end result, or outcome, of your healthcare depends to a large extent on what your health problems and unique healthcare requirements are.
Quality over quantity
Value-based care favors quality of care over quantity of care. To illustrate this using just one aspect of a much broader system that has several other measures to increase efficiency, let’s consider clinical appointments.
In the value-based care system, doctors put in time and effort to have fewer, but more in-depth meetings with patients rather than having patients come to the clinic repeatedly for short, hurried, and unfulfilling consultations.
This can be a huge benefit to patients who have limited mobility and can’t arrange a ride to the clinic every few days. People also have responsibilities and commitments; they can’t put their entire day on hold just to sit tight for hours in a clinic’s waiting room only to get a rushed, 5-minute meeting with the doctor.
Some examples of value-based care
Because different people consider different things as valuable, let’s look at two examples that illustrate the concept of value-based care.
Example 1: A senior patient with type 2 diabetes tells their primary care physician that they want control over their blood glucose, and want to manage their diabetes in a way that doesn’t require insulin shots.
From this, we see that the value this person wants to derive from their healthcare at this particular point in time is: not needing insulin shots.
With type 2 diabetes, in some cases it is entirely possible to reduce dependency on medication or insulin, and manage the chronic disease mainly with good diet and exercise.
Knowing this, physicians operating in the value-based care model will create diet and exercise plans, and pull in resources to help the patient get the value they seek from their care. These resources could comprise a dedicated dietitian or nutritionist, enrolling the patient into a medical program to quit smoking, referring them to sleep experts, and so on.
All these efforts will work towards enabling this particular patient to bring their blood glucose levels under control without needing injectable insulin or even oral diabetes medication.
Example 2: A healthcare center operating on the value-based care model sends out vaccination reminders to patients just before flu season kicks in.
The clinic’s staff may be doubly concerned about its more vulnerable patients, such as those diagnosed with chronic obstructive pulmonary disease (COPD), as a bout of flu can lead to severe complications like pneumonia, respiratory failure, or a collapsed lung.
Should this happen, the patient will have to deal with physical damage to their body, mental and emotional distress, and the high costs of advanced medical care.
Conscientious care providers do not want their patients to go through this kind of trauma. So, in addition to sending reminder notices, clinic staff may call such high-risk patients on the phone to confirm they’re coming in for their flu shots. A day or so after the shots have been administered, staff may call the patient to check in on them and make sure they’re not experiencing any side effects.
In this example, the flu vaccine is a preventative care measure, the multiple reminders and post-vaccine check-ins are a form of coordinated care, and the outcome is keeping the patient safe from potential threats arising from disease complications.
All together, these make up value-based care.
Components of value-based care that matter to patients
The major components of value-based care relevant to the patient’s perspective are:
- Preventative care
- Patient-centered care
- Coordinated care
- Patient outcomes
What is preventative care
In the sitcom ‘The Big Bang Theory’, there’s a running gag about the check engine light in Penny’s car. Other characters point out it’s a warning that her car’s not fine and she should take it to a mechanic, but Penny dismisses their concerns. Eventually, the car breaks down and has to be scrapped.
If you replaced Penny with yourself, her car with your health, and the mechanic with a primary care physician, it’s pretty easy to see what, and how important, preventative care is.
Unlike cars, your body doesn’t have a light to tell you something is wrong. But it does give warning signs in several ways.
Preventative care begins with paying attention to these warning signs as soon as, or even before, they start blinking. The next step is to identify what health conditions the signs are pointing to, and catch any potential illnesses or diseases before they get out of hand and land you in the hospital.
Medicare Annual Wellness Visits
Your Medicare Annual Wellness Visit plays a big part in preventative care. During this once-a-year, free visit to your healthcare center, your primary care provider will go over your medical history, discuss any changes to your mental and physical well-being since your last visit, vaccinations you’ve had, all the medications you take and any side effects experienced, your diet and nutrition, exercise, and so on.
What is patient-centered care
In patient-centered care, patients are at the heart of all decisions made regarding their healthcare, get a say in their treatment plans and programs, and remain actively engaged in care processes.
What is coordinated care
As a senior adult, it is possible that you may have more than one chronic illness. This is known as comorbidity.
Comorbidities can be related, such as having insomnia alongside Restless Legs Syndrome, or they can be completely independent of each other, such as having a food allergy and arthritis.
Comorbidities mean that as well as having a primary care physician, you may also need to see specialist care providers. Coordinated care, which is an essential part of the value-based care system, lets all your care providers work effectively as a team even if they’re not located in the same clinic, or even the same county or state.
Your health records are accessible to all your care providers, so they can see what diagnostic tests you’ve had and the results of those tests. This way, you do not have to undergo the same tests repeatedly for each individual doctor.
Your doctors can also see all the medications prescribed to you. This saves one provider from prescribing a medication another may have already prescribed, and also lets physicians check for drug interactions before they prescribe new meds.
What are patient outcomes
Outcomes are results. In value-based healthcare, individual patient outcomes measure how well your health is coming along as a result of your care providers’ treatments.
Is your weight within range for your height and age? Is your HDL consistently higher than LDL? Are your teeth looking and feeling good? Have you been able to avoid hospitalization for the simple reason that you just don’t need it, because you and your care providers are practicing great preventative care?
These are just some of the results, or outcomes, that care providers in the value-based care system want for their patients.
Value-based care sounds great! How do I get in on it?
Most Medicare Advantage (MA) plans follow the value-based care model. Recent findings show that Medicare Advantage plans are gaining steadily on Original Medicare, with the ratio standing at 54:46 in favor of Medicare Advantage plans.
The Medicare Advantage Open Enrollment Period runs from January 1st to March 31st each year. This is when you can change or modify your current Medicare Advantage plan, or enroll into a new Medicare Advantage plan and become part of the value-based care system.
To find out how to switch to a Medicare Advantage plan, or upgrade your existing plan, speak to a staff member at your nearest value-based care healthcare center, or call the IntraCare Patient Relations Team’s Helpline 800-941-1106, Mon-Fri, 8am-5pm CST.