What is Value-Based Care?

Posted by Kellie Collier on Jun 21, 2018 4:41:23 PM


If you visit a healthcare provider frequently, you may have heard the term “value-based care”, or VBC. In a basic sense, value-based care is a model that pays a healthcare provider based on the patient’s health outcome. This means providers are incentivized to provide better, more effective care in exchange for payment. As the phrase goes, VBC would be quality over quantity.

Most of our country's heath care system is set up on a fee-for-service environment, where each appointment and visit is treated separately for payment purposes. This can lead to the request of more tests, follow up visits and procedures – taking up both you and your doctor’s time and increasing overall costs. VBC would pay providers based on how well they keep you healthy, disrupting the traditional health care system we currently know today.

How well does this model fit the workers’ compensation system? Jury is still out. When explained to an injured worker, the thought of receiving the highest quality of care in the shortest amount of time might be enticing. Unfortunately, a change in model comes with its own set of challenges – and workers’ comp doesn’t look like they are ready to take that on just yet.

Related: Why Can't I Fill My Prescription?

What should ring true with all stakeholders of the workers’ comp system – injured workers, payers, providers, and regulators – is that outcomes are important. Before VBC can be a consideration within workers’ comp, stakeholders must agree on what constitutes as a positive patient outcome.

Today, over 400 accountable case organizations (ACOs) have been created as a result of the Affordable Care Act, helping to deliver value-based care to people across the country. Before VBC can even be considered within workers’ comp as more than a pilot program, stakeholders must come together to share their thoughts, analyze data and develop a road map for true success.

Topics: Workers' Compensation