How you benefit from value-based care

Perspectives: Healthcare today

According to the New England Journal of Medicine, value-based care ties the amount healthcare providers are paid based on their patients' results. In other words, they’re rewarded for helping patients lower the frequency and seriousness of long-term health issues and improve their total health.

Value-based care leads to care coordination

Value-based care encourages teamwork and integration from physicians and hospitals, because instead of being paid by every service they perform, they receive a single, bundled fee.

Under this fixed payment system, physicians and hospitals are motivated to keep patients well and out of the hospital, and keep costs under control. When they do a good job of caring for patients and keeping them healthy, they benefit by keeping more of the single, bundled payment. If they don’t do a good job, they may lose some of their payment. 

With value-based care, primary care physicians are often the front line of the healthcare system, responsible for preventing or finding health issues early and acting quickly to address them. This creates a greater need for teamwork with other physicians when it comes to care coordination and integration.

At Carelon Health, our advanced primary care puts primary care doctors at the center. They’re supported by a local team of advanced-practice providers, nurse practitioners, nurses, specialists, pharmacists, behavioral health clinicians, social workers, and community health workers. The entire team is committed to a patient’s whole health.

What care coordination looks like

If you’re a patient seeing a primary care physician, nurse practitioner, or specialist who’s part of a value-based care model, you’re not just seeing one person. Most often, you’re working with a team. Even if they aren’t in the room, your care team is working together to understand your health, share information and expertise, review options, and recommend the best care for you. 

When you see a Carelon Health provider, you may notice that:

  • You’re not rushed during your appointment.
  • You have time to ask questions and get clear answers.
  • Your doctor learns about your health history and current health.
  • There’s care coordination and integration.
  • Your treatment plan is based on the best available evidence and is truly needed.

The difference between value-based care and fee-for-service

Traditionally, the United States has used a fee-for-service model. With this model, physicians are paid based on the number of healthcare services they perform, no matter what the result. Like an auto mechanic, they’re paid for each thing they do, such as changing the oil, rotating the tires, and replacing spark plugs.   

With fee-for-service, physicians may not be paid for talking about the patient’s case with a specialist, or for following up with a specialist after providing a referral. In addition, a specialist may have little motivation to talk about their findings with the primary care physician.    

These gaps in communication can cause information that should be shared, to be lost. That can lead to care that’s incomplete, which means a poor result for the patient.  

The benefits of value-based care and care coordination

When comparing value-based and fee-for-service care models, it’s easy to see how value-based care promotes communication between members of a clinical team, better care coordination, and a more comprehensive, whole-person care plan.