Categories: Health

How Value-Based Care Could Transform Healthcare In The US

Healthcare today, especially in the US, is at a critical juncture. Costs are high all over, and they continue to keep rising. The new administration has taken upon itself to instill changes that should improve how the healthcare system works and how patients are treated.

One of the bigger changes being rolled out is the gradual shifting of health providers to a new model of healthcare delivery, namely value-based care. But what is value-based care, and how could it transform the healthcare industry in the US?

A new and radical approach to healthcare

Value-based care is a healthcare delivery model in which healthcare providers are paid and given incentives based on the quality of care they give to their patients, and how healthier their patients become. This necessitates health providers to choose more effective and intensive treatment plans for their patients, usually with the aid of new tools such as machine intelligence technologies.

This new model differs from the current model of healthcare, which pays on a quantity of care basis, i.e. health providers getting paid for the amount of healthcare services they deliver and how many patients they treat.

What does it all mean, then? To put it simply, under value-based care, healthcare providers will have to focus on giving the best quality healthcare they can give a patient, rather than the amount.

Instead of ordering barrage after barrage of tests—which would have earned them more money in the traditional model—doctors will only order procedures that are necessary for the quicker recovery and improved well-being of the patient.

The same goes for treatments and prescription medicines, with only those that are proven to work best for the patient’s condition being considered and given.

Everyone benefits under value-based care

While this may seem like a burden on hospitals and their staff, it really isn’t. Hospitals stand to actually save more money by cutting down on unnecessary procedures, as well as having to treat the unfortunate side effects and complications those procedures might cause.

 Also, by lessening the number of procedures and checkups a single patient has to undertake, it frees up staff and resources to attend to more patients.

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Insurance providers and health payers stand to benefit from value-based care as well. As this new healthcare delivery model continues to gain traction, the culture of health in the US will move from a reactive and chronic management mindset to a proactive, preventative mindset.

With hospitals and doctors focusing on getting their patients healthy and having them stay that way, it translates into less healthcare claims being made. Thus, there is also less drain on the payers’ premium pool and investments.

And of course, the patient benefits from value-based care as well. Not only can they finally enjoy the best in healthcare exactly when they need it, but also at a lower cost. The intensive and preventative treatment will also push patients to participate more in making themselves healthier, thus enhancing their quality of life and preventing the onset of chronic diseases.

Value-based care is impossible without the right solutions

In the value-based future of healthcare, the burden is on the healthcare provider to provide the best healthcare plan possible for their patients—one that would not only give them the most positive outcome, but also present the least cost. It’s a careful balancing act.

Thankfully, there is a tool that could assist greatly in this endeavor, and it’s called big data mining and analysis. This is the concept of using sophisticated, self-learning computer programs to sift through large electronic databases in order to find links and patterns, and correlate them to whatever the database owner desires.

How would this apply to the healthcare industry, and in a value-based care aspect? We can answer this through a working example. For instance, let’s assume a healthcare provider is treating a patient that requires a specific surgical procedure.

By analyzing their electronic medical record (EMR) database with a self-learning program, the health provider can quickly identify which surgeon in their payroll has the highest success rating for that procedure, as well as whose patients has the fastest recovery rate.

They can go deeper into the analysis by also tracking which medication aids the most in patient recovery, and which has the least reported complications.

Armed with all this information, the health provider can now map the best plan of treatment for their patient, one that would not only give them the best outcome possible but also have them pay less—since a faster recovery rate would mean a shorter stay in the hospital. Thus value-based care’s requirements for both quality and cost are achieved.

Value-based care may be a challenging step to take, but with powerful analytical solutions designed to manage clinical variations, it can be done.


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