Debunking 3 Myths About Value-Based Care

Rob Cetti – President

The number of patients treated in a value-based care environment could nearly double within five years, according to recent research by McKinsey & Company. However, the study also suggests that despite physicians’ increased appetite for embracing value-based care, its adoption is uneven. The question is: Why?

Perhaps it’s because of misunderstandings about value-based care. Misconceptions wouldn’t be surprising, given that several “flavors” of value-based care now exist. In addition, because value-based care disrupts long-standing care delivery and reimbursement models, providers have likely encountered myths about its impact on care quality, financial viability, and more.

So, let’s set the record straight. We’ll start by clearly defining value-based care and then dispelling a few common misconceptions.

Defining the “value” of value-based care

Value-based programs can be structured in many ways, but they all share one attribute. Namely, they shift from a fee-for-service approach to a pay-for-value methodology. In the simplest terms, value-based care can be defined as delivery/reimbursement models designed to reward efficient, effective, high-quality, and patient-centric care. 

Achieving all of those goals is a tall order, to be sure. That’s why, from a practical perspective, success in value-based care typically requires teamwork. Collaboration is essential to share and analyze data, enhance communications, and drive process improvement.   

However, with the proper partnerships in place, value-based care models offer numerous benefits to providers and the patients they serve. It’s time to debunk some prevailing myths. 

Myth #1: Physicians must choose between delivering value-based care and remaining independent

A recent analysis by the American Medical Association reveals that physicians increasingly work in practices that are at least partly owned by a hospital or health system. Why? 70% desired better access to resources and help managing payers’ economic, administrative and regulatory burdens. Looking through this lens, some find it logical to assume an independent practice could never meet the demands of value-based care.

But in truth, physicians have options that empower both autonomy and value-based care.

For example, CareAllies supports independent physicians by alleviating the administrative and operational burdens of participating in value-based care models. We assist with contracting, quality performance, data and analytics, and more. And we do these things from the physician’s perspective to ensure changes enhance provider workflows rather than add unnecessary inconveniences.

By assisting practices operationally, organizations like CareAllies enable physicians to keep their autonomy and participate in value-based care.

Myth #2: Value-based care is financially disadvantageous

Some value-based care models feature “shared risk” or “shared savings” elements. While these concepts may push some physicians outside their comfort zone, they aren’t inherently detrimental to the balance sheet. 

On the contrary, value-based care models can actually insulate practices from the many market pressures that have traditionally driven physicians to align with larger health systems. During the pandemic, for instance, physicians already operating within capitated value-based care models had the flexibility to quickly shift to virtual care, allowing for continual revenue streams.

Because value-based care models reward care quality over care quantity, physicians in advanced value-based care models can be less concerned about the inevitable ups and downs of visit volumes and more focused on ensuring high-quality patient care. Plus, with assistance from partners like CareAllies, they can feel confident about contract due diligence.

Myth #3: Value-based care complicates care delivery

Delivering the patient-centric care that is the hallmark of successful value-based care is not simple. But once again, teamwork can firmly put the “complication” idea into the “myth” category.

With access to the right data and resources, physicians can identify gaps in care, understand which patients need additional support, address social determinants of health (SDOH), and reduce barriers to care. Rather than complicate care delivery, value-based care enables physicians to champion the coordinated, preventive, and holistic approach they’ve long wanted to offer their patients. As a result, patients should experience decreased avoidable emergency room visits and hospital readmissions, which can lower costs and improve overall care quality.

A bright future for value-based care

At their core, value-based care models strive to incentivize keeping individuals and communities healthier. There is no question that they mark a distinct change from fee-for-service. So, as with any transformation, myths and misconceptions are to be expected.

Still, a clear-eyed assessment of the facts can quickly banish misunderstandings. The focus on whole-patient care is meant to simultaneously drive efficiency and quality—which in and of themselves should encourage more adoption of value-based care models across the board.