Value-based care is gaining momentum in the U.S. It offers a solution to several of the challenges that face the nation’s health care system, including rising costs and the prevalence of chronic conditions.
Put simply: value-based care drives care quality up and costs down.
Value-based care vs. fee-for-service
The traditional care delivery model that accounts for most of U.S. health care is fee-for-service, where payors reimburse health care providers based on the services they deliver, such as office visits, procedures and tests.
Under a value-based care model, provider payments are instead tied to patients’ health outcomes, incentivizing care quality rather than the number of services completed. Providers are rewarded when patients are healthier.
Bringing value-based care to fruition
Three major components enable value-based care.
- Clinical and demographic data helps providers and payors develop comprehensive pictures of their populations, including their health needs and risks of complications.
- Team-based care addresses each patient’s individual needs and may include physicians, nurses, pharmacists, behavioral health specialists and community health workers.
- Aligned incentives, such as targets for quality and cost, between payors and providers facilitate reimbursement based on patients’ health outcomes.
Benefits of value-based care for patients
There are several ways that value-based care supports patients’ health.
- By emphasizing preventive care, providers can identify health risks and intervene early.
- Patients with chronic conditions — which are often complex to manage and costly if left untreated — are regularly engaged with care that helps them stay on track and monitor disease progression.
- Primary care teams coordinate with patients’ specialty care providers and even look beyond clinical care to help address social factors, such as access to transportation and healthy food, that influence patients’ health.
Together, these attributes of value-based care create more connected experiences for patients and help reduce avoidable, costly emergency department visits and hospital admissions.
"We spend a lot of money per person on health care in the U.S. compared to other countries, yet we don’t see the same health outcomes,” says Sree Chaguturu, MD, EVP and President, Health Care Delivery, CVS Health. “We’re working diligently to advance value-based care at CVS Health because we believe it is the way forward to making people healthier and driving down the skyrocketing costs of care.”
Delivering and supporting value-based care
CVS Health is helping expand access to value-based care.
- At over 230 Oak Street Health® centers across the country — many located in socially disadvantaged areas — Oak Street delivers primary care tailored to the unique needs of older adults, integrating physical, behavioral and social care. Its value-based care model has led to a 44% reduction in hospital admissions compared to similar Medicare patient populations.1
- Beyond its roots in acute care, MinuteClinic® has expanded to provide preventive care and chronic condition management nationwide, as well as longitudinal primary care in a growing set of markets. This evolution has set MinuteClinic up to enter value-based care constructs.
- Aetna® has grown its network of providers with value-based arrangements. As a payor, Aetna partners with providers to develop strategies and tools, share data that helps them make the best decisions for their patients, and track results to improve care and the member experience.
As a fundamental shift in how we collaborate across the health care industry, value-based care is key to making care better, simpler and less costly.
