What are value-based care programs?

What are value-based care programs?

The move toward value-based care began in 2008 with the passage of the Medicare Improvements for Patients & Providers Act (MIPPA). Ten years later, in 2018, there are a number of value-based programs designed to reward healthcare providers for the quality of their care rather than the number of patient visits.

The Centers for Medicare & Medicaid Services (CMS) states that its value-based programs support their three-part aim of:

  • Better care for individuals
  • Better health for populations
  • Lower cost

The five original value-based programs had as their goal the linking of provider performance of quality measures to provider payment:

  • End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
  • Hospital Value-Based Purchasing (HVBP) Program
  • Hospital Readmission Reduction (HRR) Program
  • Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
  • Hospital Acquired Conditions (HAC) Reduction Program

In further promoting the goal of providing quality care to patients, increasing the focus on value-based care over the frequency of patient visits, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created a Quality Payment Program (QPP). The QPP:

  • Changes the way that Medicare rewards clinicians for value over volume
  • Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)
  • Gives bonus payments for participation in eligible alternative payment models (APMs)

CMS states that their value-based programs are important because they encourage a move toward paying providers based on the quality, rather than the quantity of care they give patients. Fewer hospital readmissions, coordinated care between healthcare providers, and reduced costs for patients and providers are some of the anticipated results of the value-based care programs.

Electronic health records (EHRs) are also an essential element in value-based care programs. Providers who take advantage of the many features of an EHR system, including accessing patient information immediately, coordinating with a patient’s specialty providers, and communicating with patients securely are better equipped to provide the quality care that is the ultimate goal of value-based care.