Value-Based Care Transition

Miami, FL -- (SBWIRE) -- 09/16/2020 -- Many value systems continue to be built on a fee-for-service foundation, where doctors are being limited in what they are able to do with the traditional billing and coding methods. These systems too frequently calculate procedures versus outcomes (for example, blood pressure tests versus actual progress and reducing hospitalization). It is not clear whether determined actions will result in the genuinely desired outcome of less costly, more sustainable healthcare, and those actions say nothing about real patient experiences.

A primary care doctor, on average, sees around thirty patients a day. At $80 a visit, this produces roughly $600,000 annually. In addition to trying to keep patient visits brief, there is still a huge amount of paperwork that needs to be filled out. The provider hopes to take home a fraction of what specialists receive after covering the costs of operating the practice. There's little gain from value-based insurance payouts, irrespective of their PCP performance.

What if those patients were assumed "full" risk by the doctor, who took greater responsibility for them? Things change dramatically. Assuming payor arrangements were resolved, that same provider could have nearly $12 million (about $500 per patient per month), about twenty times the income. There is always the risk the $12 million will be used up, and the doctor will suffer a loss. Primary care is worth more than five percent ($600,000 of the $12 million) of total costs the doctor receives in the fee-for-service setting since PCPs would redefine the use of "downstream" services. To reduce spending the other 95 percent of preventable, avoidable, and unsustainable care, it all becomes how patient well-being can be maximized. Working with patients is about motivating them to do what's needed to have a positive impact.

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