agilon health : What Exactly Is Value-Based Care?

Value-based care. It sounds like an industry buzzword, but behind it is the key to changing healthcare in the US, enabling better outcomes and less spend. And when it comes to primary care physician practices, the transformation to value-based care (VBC) can mean the difference from continuing to support patients versus closing up for good.

At agilon health, we partner with primary care physician (PCP) groups – who are trusted fixtures in their communities – to empower them to move to a total-care model that provides more holistic, value-based care to their senior patients. It’s an urgent need, with more than 10,000 new seniors entering Medicare daily.

But what exactly is VBC?

More Than a Change in Billing

Much of the focus on value-based care is that it changes physician compensation from fee-for-service (FFS) – a model driven by the quantity of visits – to one that rewards based on outcomes. It might include a monthly stipend for ongoing preventative care of chronically ill patients, or a bonus for keeping seniors out of the expensive hospital setting. A great example is the increase in health screenings in value-based care, estimated to be between 8% and 20% higher than in FFS models.

Value-based care is about wellness rather than illness and about prevention rather than reacting to health crises. When a physician helps diabetic patients maintain their blood sugar and avoid a hyperglycemic visit to the hospital, that’s invaluable to the patient and an outcome the PCP can be compensated for. That’s value-based care.

A Patient-Centric, Holistic Approach Led by the PCP

At agilon health, we believe the key to value-based care is putting the PCP at the center, so they can serve as the quarterback of care for their senior patients. That means monitoring for more than traditional health concerns – it also means paying attention to social determinants of health. A patient with an unsafe home environment or on a limited budget may find it difficult to adhere to physician advice. But when the PCP is able to coordinate having a social worker visit their home to help address those issues, the patient’s health improves. That’s value-based care.

Many PCP practices are able to use their transformation to VBC to provide better services to their senior patients, all with the goal of improved care. We’ve seen agilon health partners establish extensivist clinics that lessen ER visits and allow patients to be cared for at home. Or they hire a complex care manager to keep in touch with chronically ill patients between visits and promote adherence to recommended care.

Taking Advantage of Technology and Data

Efficient VBC uses data and a population health approach to provide better care, lower costs, and reduce the need for unnecessary services. The power of data analytics can illustrate trends to guide decision-making, identify high-risk patients, and monitor for areas of improvement. That’s value-based care.

With the advantage of technology, practices focused on value-based care have an easier time recording patient health data and managing to positive outcomes. In addition, most VBC practices also use electronic heath records that can connect them to specialists, therapists, social workers and more, providing a more transparent view of patient health.

In short, a robust technology infrastructure undpins any good value-based care model and is central to its effective operation.

A Key to Preserving Primary Care

Healthcare in the US is changing. In fact, in the 2020 Deloitte Survey of US Physicians, 50% of physicians expected a great deal of change in their specialty within the next 10 years. For PCPs, that number rose to 61%.

Fee-for-service models are exhausting PCPs with their quantity demands and making it difficult for the economics of an community-based practice to work. Yet, these primary care physicians have a unique relationship with their patients – many of whom they’ve seen for decades – and a central role to play in providing value-based care. There is no one who knows their senior patients better.

Value-based Care is the Future

Value-based care combined with the benefits and influence of PCPs is winning solution for US healthcare and for patients. It’s no wonder the Centers for Medicare & Medicaid Services’ Innovation Center has set a goal to transition all Medicare beneficiaries to a total care model relationship by 2030.

We’re just beginning to see the impact of value-based care on US healthcare, but more importantly, we’re only just starting to realize what it can mean for senior patients.

And that’s the power of value-based care.

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