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The US market loses serious dollars in lost productivity due to health-related conditions – more than $225 billion, according to a report by Carlos Luna, director of government affairs for MDGuidelines. In response, Luna says employers are looking for alternatives that would deliver the “best medical results at the best prices” for workers on the mend.
That’s a key reason why the concept of value-based care is gaining traction among employers. In his report, Luna revealed that 40% of employers are exploring the possibility of implementing value-based care or high-performing networks in the coming year.
“Specifically, industry leaders stress that the nearly 10-year movement to replace unsustainable fee-for-service models is finally making inroads and becoming a reality,” he said. “The majority of today’s physicians are still primarily paid for each patient encounter – a model that contributes to lengthy utilization reviews for treatment, rising costs and patient dissatisfaction.”
Given this reality, Luna noted that stakeholders increasingly feel a need to jump-start value-based models. “As this shift continues, workers’ comp leaders will continue to see that value-based care ties provider payments to patient and financial outcomes,” he said.
Luna cited two major benefits of the value-based model. First, it standardizes care and reduces variations in its delivery. “One of the keys to controlling costs and improving outcomes is eliminating unnecessary variations in care, which can prolong health problems and delay an employee’s return to health,” he explained.
Second, because the model relies on evidence-based protocols, it’s easier to achieve desirable cost and quality outcomes. Finally, value-based care provides incentives for better outcomes, in contrast to the fee-for-service model, where physicians are compensated based on the volume of services they provide.
“More treatment equals more money – and is associated with more fragmentation, waste, redundancies and no assurance of quality,” Luna said. “But when physicians are paid for performance, compensation is based on the value of services and the overall impact on patients’ health.”
In a broader context, Luna pointed out that 55% of Medicare accountable care organizations [ACOs] that adopted the model in 2015 realized shared savings, while nearly one-third earned shared savings bonuses.
Another report published on the website Health A‑ airs concurred, saying that “while more ACOs are succeeding under the program, there continues to be substantial variation in financial performance and quality results. This variation underscores that payment reform alone is not enough to improve quality and reduce costs, but rather that organizations must also transform the way care is delivered.” “Workers’ comp shouldn’t be left behind in this transformation,” Luna said, “and the good news is that there are more data and tools to support the shift than ever before.”
