Value-based care -- transforming health care with better collaboration and improved health outcomes

Value-based models are the leaders in incentivizing providers to provide quality care, and with good reason. Unlike other reimbursement and care models, a value-based approach holds providers accountable for the costs of care as well as producing better health outcomes for their patients.

Value-based care is transforming health care by giving health care professionals incentives to provide quality care with a better patient experience and lower costs. Unlike traditional fee-for service (or pay-per-service) payment models, which are often poorly coordinated and fragmented, value-based care puts the focus on the quality of care not the number of services a patient receives.

According to the Institute for Healthcare Policy and Innovation, simply put, when thinking about the “value” in value-based care, health care professionals must consider which health care services provide the greatest possible health benefit at the lowest possible cost and which services may offer little to no benefit at all.¹

How population health improves provider collaboration and outcomes in value-based arrangements

Population health plays an important role in value-based care. As the health of groups of individuals improves, so does the health of the population. A healthy population provides many benefits:

More individuals are healthy
Less people need care
Health care costs are lower
Health care providers can determine what's keeping people more healthy

Population health looks at the health of a group of people rather than just the health of one person at a time.² By focusing on population health, health care professionals and others across the industry, including insurers, have an opportunity to collaborate and to improve the health outcomes of the communities they serve.³

In fact, many providers have developed strategies of population health management that support patients' quality of care, increasing access and improved patient experience. As they treat individuals, they are also seeing trends and documenting best practices that can help other patients avoid more costly, less effective treatments, or perhaps even avoid needing care at all.

Horizon BCBSNJ and providers – working together to improve health

With our value-based programs, providers and Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) work hand-in-hand to improve health care quality and affordability in New Jersey communities. Information and data is shared between providers and Horizon BCBSNJ, and is used to better understand patients' conditions or treatments and to improve the patient experience. The value-based care model puts the responsibility of quality care on both providers and Horizon BCBSNJ, which helps improve outcomes and keeps costs low. Value-based care puts the patient first.

“We've seen the importance of working with health care professionals to establish successful patient-centered, value-based programs,” said Dr. Steven Peskin, Executive Medical Director, Horizon BCBSNJ. “By working together, we can develop a health care system that encourages greater transparency for our members to know more about the cost and quality of the care they seek, and to make health care easier to navigate and more cost effective.”

With providers and Horizon BCBSNJ working together, using patient data for insights and incentives to provide better patient outcomes, value-based care models establish the foundation needed to transform health systems and promote healthier communities at lower costs. And while there is still work to be done, much progress has been made.

“Our value-based arrangements are important because it means we can work closely with our value-based partners to focus on quality measures and provide incentives for them to meet or exceed those measures,” said Dr. Peskin.

In 2021, we will keep looking at ways to enrich our value-based programs. This includes expanding our Episodes of Care programs to include additional conditions and procedures. We also will continue to integrate technology to share information with tools such as HealthSphere, our comprehensive data tool that offers detailed insights to a patient's health status and history. Finally, we will continue leveraging best practices from the industry and collaborating with providers so that we can strengthen and develop these programs. Value-based care is a testament to our commitment to deliver on improved health outcomes for our members, and to enhance the patient experience — a commitment that empowers our members to achieve their best health.

¹ https://ihpi.umich.edu/annualreport/2019/healthcare-value
² https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf
³ https://onlinepublichealth.gwu.edu/resources/what-is-population-health/