Question

Identify how the Value-Based reimbursement model has evolved.

Answer 1

WHAT IS VALUE BASED REIMBURSEMENT MODEL ?

A model where payment is outcome based and providers are rewarded according to the quality of the treatment received.

The major aims of value-based reimbursement model are implementing continuum of care, enhancing the patient experience, standardising outcome and cost of care, and treatment delivery through a collaborative chain of activities with measurable outcomes.

HOW THE VALUE BASED REIMBURSEMENT MODEL EVOLVED?

Earlier we had fee for service model (Quantity-based system in which fees are paid for every service provided) , which created a conflict of interest as it provides incentives to caregivers based on a higher number of visits, procedures, tests, treatment, etc., which may not be in line with patient health and wellness, which icreased health care expenditure and lead to inefficient services, hence value based reimbursement model evolved.

The need for value-based reimbursement model to evolve was because of increasing healthcare expenditure, excess healthcare costs attributed to unnecessary and inefficient services along with uncoordinated care. All these factors coupled with increased patient expectations have set the stage for the adoption of value-based healthcare, where the payment for care is tied to clinical outcomes and service quality.

Implementation of value-based care would require the building blocks of public financing, resource availability, utilisation of technology and a collaborative ecosystem. After implementaion value-based reimbursement model will likely result in today’s fragmented care delivery evolving into tomorrow’s circle of care. If implemented as envisaged, in five years, we could look at saving almost 9 lakh lives and reducing healthcare cost to more than 55 percent.