Boston, MA - August 18, 2020
, a leading provider of medical professional liability insurance, today released its latest Red Signal ReportSM
Value-Based Care. The report examines the healthcare industry’s shift from volume-based reimbursement to value-based care (VBC) models, as providers seek to improve care quality and reduce costs.
Currently, less than 20 percent of Medicare spending is value-based; however, the Centers for Medicare & Medicaid Services (CMS) goal is to have 100 percent of providers participating in upside and downside value-based care contracts by 2025. This move shifts as much as $500 billion of economic risk from CMS to providers and private market participants while simultaneously rewarding improved quality care.
“The combination of COVID-19 and an economic recession has only accelerated the transition to value-based care as employers and consumers look for ways to manage spending, driving the demand for value,” said Brian York, vice president, value based care, Coverys. “Additionally, during the first COVID-19 surge, many providers who transitioned to value-based fared better than those who leaned entirely on fee-for-service models. For these providers, revenue remained consistent during lockdowns while elective procedures were delayed and canceled, further underscoring its value to providers.”
The Red Signal Report addresses the current climate impacting VBC adoption and highlights its long-term benefits. These include the opportunity to significantly grow revenue and profits, diversify revenue sources beyond fee-for-service and improve quality care through patient engagement, care management, telehealth, and better care transitions.
The report also examines the technical, insurance and performance risks associated with the shift to VBC and provides insights on methods for managing episodes of care to mitigate risk, including:
- Care coordination – Providers must be prepared to successfully execute individualized care plans designed to help patients recover and return home as quickly and safely as possible.
- Care transitions – Transitions of care occur when patients are at their most vulnerable, so heightened attention in this phase of care is a key opportunity to reduce costs and inefficiencies while improving the quality of care rendered.
- Preferred provider networks – To be successful, providers must develop networks of high-quality and high-value providers that are engaged at any point during the patient’s episode of care.
- Patient tracking – Providers need the ability to track, in real time, the various stages the patient is going through during their episode of care. Accurately monitoring the patient’s treatment allows immediate interventions to improve quality and reduce unnecessary costs.
Download a free copy of the report
today to learn more about the strategies for mitigating downside risk and successfully transitioning to value-based care.
The report is co-authored by Brian York, vice president of value-based care, Coverys; David Terry, CEO and founder, Archway Health; Ben Gardner, senior vice president of sales and marketing, Archway Health; and Keely Macmillan, senior vice president of policy and solutions management, Archway Health.