Fact: According to the National Health Expenditures Accounts, healthcare spending in the US accounted for over 18% of the country’s gross domestic product (GDP) in 2021. That’s up to 6% more expensive than neighboring countries such as Canada and the UK.
And yet, the US healthcare system is still lagging in many ways. Although it produces some of the best medical results in the world, the US also produces some unnecessary or ineffective care.
As such, the US government is sharpening its focus on the value-based care model. This comprehensive guide deeply delves into value-based care, its functions and benefits. In addition, this article also touches on behavioral health integration (BHI, a core element of value-based care, its benefits, and the basics of BHI technologies).
Value-Based Care: What Exactly is it?
Value-based care is a healthcare model that incentivizes healthcare providers to focus on quality instead of quantity. This means that healthcare providers are compensated based on a patient’s health outcomes.
As such, healthcare providers become more focused on promoting quality patient care and helping patients enjoy healthier lives via evidence-based medicine. This healthcare model aims to reform how traditional healthcare is delivered and paid for.
Traditional Fee-for-Service vs. Value-Based Care
Traditionally, under the fee-for-service model, doctors receive payment for every patient they see, the test they order, and the service they provide. Reimbursement rates are established for every service a doctor provides. Therefore, they are incentivized to offer more services per patient. Over time, experts learned that this wasn’t the best way to provide care since it often leads to unnecessary care or overtreatment.
As such, the passage of the Affordable Care Act (ACA) in 2010 helped reform the US healthcare system, giving birth to value-based healthcare. With value-based healthcare, doctors are incentivized when they’re able to prove that the test and services they provided helped improve a patient’s health. In this case, there’s more focus on value instead of volume.
Another critical difference between traditional and value-based care is the shift from reactive to proactive care. This means that instead of treating patients after they’re already sick, healthcare providers are now focusing on prevention strategies such as BHI and detecting chronic conditions in their earliest stages when they’re less expensive and easier to treat. The main goal is to provide better health and reduce hospital or emergency room trips.
Value-Based Care and its Benefits
Shifting to a value-based healthcare model offers numerous advantages to providers, patients, insurance providers, and the greater population.
It Helps Reduce Costs
Cost reduction is the main benefit of value-based healthcare since it focuses on proactive prevention and recovery, which results in less spending.
Preventing or managing chronic conditions and diseases such as high blood pressure or diabetes leads to fewer hospitalizations, emergency room visits, readmissions, and more affordable medications.
It Enhances Patient Experience and Satisfaction
When healthcare providers focus on giving value instead of meeting more patients in a day, healthcare quality also improves. In turn, it helps improve patients’ experience and overall satisfaction with their healthcare plans. Value-based care also helps increase trust in healthcare providers, enhancing patient engagement and improving care outcomes.
It Boosts Operational Efficiency
By lowering costs associated with chronic illness management, a healthcare provider can free up funds that can be used for more efficient workflows. A provider can invest more in procuring technologies such as check-in kiosks and telehealth, which ultimately help improve better care outcomes.
Moreover, providers can also spend more time on preventive medicine instead of struggling to keep up with high patient visits and readmissions.
It Improves Care Coordination
With the traditional care model, a healthcare provider doesn’t always have the incentive to work with other professionals to provide adequate patient care. However, in a value-based care system, providers are encouraged to turn to more coordinated and collaborative care to help create better patient outcomes.
It Reduces Payer Admin Burden and Client Risk
For insurance companies and payers, value-based care also offers significant benefits.
For one, it helps in reducing existing administrative burdens. With the traditional care system, every transaction—whether an appointment, test, or prescription—requires documentation, hands-on insight, and approvals, resulting in significant paperwork.
Since value-based care helps minimize patient treatments and transactions, it also reduces the needed paperwork, giving a direct opportunity to save money.
In addition, value-based healthcare also allows better control of overpaying for patient services. Since patients receive better care quality, it reduces ongoing care costs and urgent care needs. It also helps patients avoid paying for unnecessary or ineffective treatments.
Lastly, another benefit of value-based care for payers is that it helps reduce client risk. With a strong focus on preventive care, value-based care helps reduce patients’ risk of developing chronic conditions, ultimately reducing client premiums.
Behavioral Health Integration: A Key Element in Value-Based Care
The adoption of a value-based healthcare model has been slower than expected. However, several factors are driving the shift to develop or expand the reach of value-based care strategy.
In particular, as demand for value-based healthcare increases, providers must find innovative ways to improve clinical outcomes while lowering total care costs. In this case, behavioral health integration (BHI) has become essential to any value-based care strategy.
Understanding Behavioral Health
Behavioral health focuses on your daily cognitive habits that affect your overall well-being, biology, emotions, and behaviors. While it’s often used interchangeably with mental health, behavioral health is far more expansive. It incorporates not just your mental wellness but also how your thoughts influence you. Good behavioral health means engaging in behaviors that help you achieve an ideal physical and psychological balance.
That said, behavioral health conditions are prevalent, affecting at least 1 in 5 Americans, exponentially increasing the cost of care and hampering health outcomes. Thus, integrating behavioral care with primary care is now accepted as an effective strategy to improve patient outcomes.
What Exactly is BHI?
BHI refers to the collaborative approach between primary care teams (or any other teams in the healthcare setting) and behavioral experts to help improve patient care and outcomes using a systematic approach.
Different models or approaches may be taken to incorporate behavioral health into primary care (internal medicines, gynecology, family practice, etc.) and other specialty care (gastroenterology, cardiology, etc.).
A BHI service offers numerous components, which may include, but are not limited to:
- Systematic monitoring and assessment
- Care planning and necessary revisions for patients not showing any improvement
- Coordination and facilitation of behavioral health treatments
- Ongoing relationship and monitoring of a designated team member
The Importance of BHI to Value-Based Care
Integrating behavioral health care services into primary care can help enhance a value-based care strategy.
For one, it helps further decrease the cost of care. With behavioral health screening, providers can capture insights into a patient’s behavioral health and identify risks. This allows them to intervene and proactively manage behavioral dangers before they cause costly chronic conditions.
In addition to keeping patients out of emergencies, BHI helps address a patient’s mental and emotional needs, resulting in better overall physical health and well-being. Getting more accurate behavioral health insights can result in more chances for intervention and providing patients with the right level of care.
Furthermore, integrating behavioral health care services can help promote more accessibility and equitable treatment for a patient’s physical and mental health needs while reducing the stigma associated with this health treatment.
BHI also offers excellent benefits to clinicians and healthcare providers. It helps improve job satisfaction and the quality of life for doctors and the care team since they feel less burnout and frustration, knowing they can provide complete care for their patients’ most pressing needs.
Aside from these, other benefits of implementing behavioral health care services include:
- Closing treatment gaps
- Promoting whole-person care
- Improving patient satisfaction and health outcomes
- Reducing the risk of patient self-harm
- Promoting cost-effective and long-term value for providers
Leveraging Technology to Accelerate BHI Impact
Providers should leverage technology to address and fight the growing behavioral health crisis and positively impact value-based care models.
Providers should recognize how a comprehensive BHI solution can directly impact clinical outcomes, improve risk management, and accelerate the journey toward better value-based care. Not only that, but BHI technologies can also further enhance patient treatment and management throughout the BHI patient journey.
What’s more, regardless of where a provider starts on the path toward value-based healthcare, complementary BHI tools can be adjusted and layered to meet the shared goals of the clinicians and patient.
In general, a BHI tool can do several things to impact value-based care. These include:
- Tracking and monitoring patient progress to manage their conditions
- Identifying barriers to care to improve patient conditions
- Enhancing visibility for the entire care team, including care plans and care coordination activities
- Delivery of health education, including patient-guided dialogs and coaching for better self-management of conditions
- Proactive early intervention to avoid condition escalation
- Medication management
- Real-time syncing with Electronic Health Records (EHR) for a comprehensive overview of the patient’s condition
As you can see, value-based care creates a significant opportunity to improve the quality of care in the healthcare system while reducing costs for both providers and patients. By incentivizing quality over quantity, value-based care and robust BHI strategies can steer healthcare professionals to provide the best care possible for the best outcomes.
Hi, they call me Jenna, and I am also known for achieving a gold medal during my Ph.D. in science life. I always had a dream to educate people through my utmost writing hobby. So, I chose this blogging path, and Biomadam gave me this opportunity to present for them. I now stand to entertain you. Continue reading my articles & discuss if you’ve any confusion through the comment section below.