What Is Value-Based Primary Care?
Value-based primary care is an alternative to traditional models of insurance, which are generally fee-for-service (FFS). When you pay for care under an FFS plan, reimbursement for treatments is predetermined and is the same regardless of the outcome. With value-based primary care, physicians are reimbursed while taking into account the clinical outcome, not just the cost of the treatment or the volume of patients they see.
Why is fee-for-service a bad thing? Well, some would say that divorcing the cost of care from the outcomes leads to lower quality care at a higher price. In order to maximize profits, the care provider need only move patients through the pipeline. This model can also lead to physicians ordering unnecessary tests and procedures. FFS is what many would call a flawed incentive structure — physicians are incentivized to see more patients, not necessarily to provide quality care.
How Does It Work?
First off it's important to point out that value-based primary care is an umbrella term, so there's no one way to implement it. That said, the two most common models are direct primary care and onsite clinics.
Direct primary care isn't that much different than what you're used to. The main difference is that instead of charging flat fees for each service performed, physicians charge patients monthly, quarterly, or annual fees. This leads to physicians spending more quality time with their patients, as they don't have to rush patients through the pipeline in order to get paid.
Onsite clinics are commonly used by larger businesses trying to manage their healthcare costs. Under this model, the physicians are responsible solely for the workforce of a specific employer. Again, this involves businesses paying a flat fee to retain the services of the physicians.
What Does The Data Say?
Value-based primary care is still a relatively recent phenomenon, so the jury is still out. That said, the logic behind the idea is sound. Under the traditional FFS model, there are a number of cases involving physicians ordering unnecessary tests, treatments, or even prescribing unnecessary drugs. This can drive healthcare costs up even further and in some cases, it may even be considered insurance fraud.
The bottom line is that value-based primary care is definitely something worth looking into as healthcare costs continue to rise. It may not be as time-tested as other healthcare delivery models, but the logic is sound and the flaws in traditional FFS models are becoming more and more apparent.
At Summerlin-Roberts we leverage our expertise in cost containment to provide the best possible health benefits at the lowest possible price, resulting in happier employees and leaner budgets. For more information about providing affordable health insurance that will satisfy your employees, please contact us today.