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The Merits of Value-Based Care System

Introduction

The approaches to the establishment and organization of healthcare systems may vary based on the selected central priorities. As opposed to fee-for-service systems, value-based healthcare or accountable care shifts emphasis from the volume of services to their quality and the extent to which the offered services promote health improvement and disease prevention. This paper discusses the merits of value-based care with policy attention, differences in physicians’ practice, and collaboration.

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Main text

Current policies, such as the Affordable Care Act, have attempted to move toward value-based care, thus leading to changes in the current practice of nurses, physicians, and other professionals. The reconceptualization of patient-provider relationships, the inclusion of new actors, for instance, healthcare social workers, and the priority of care outcomes have changed these professionals’ everyday practice. For nurses, some effects of the ACA may include new opportunities to contribute to care cost reduction as care managers, coordinators, and participants of accountable care organizations (Cleveland et al., 2019). By placing focus on treatment outcomes, the ACA increases pressure on nurses related to education, which can affect the demand for nurses with at least a bachelor’s degree. Other changes relate to the introduction of the hospital readmission reduction program (HRRP) that promotes communication between physicians, a more thorough discharge planning, and increased use of EMR/EHR in information exchange (Sterbenz & Chung, 2017). Therefore, the effects of healthcare policies on practice are profound since they change priority areas relevant to patient care.

The ACA has also transformed healthcare providers’ practice when it comes to their activities as leaders and the amount of work. The law’s provisions, including the HRRP, have increased the demand for physician leaders, resulting in the introduction of chief experience officers at healthcare organizations (Sterbenz & Chung, 2017). The presence of physician CEOs has been demonstrated to improve patient satisfaction, which explains the growing popularity of MD/MBA programs, as well as continued medical education and leadership training for physicians (Sterbenz & Chung, 2017). Regarding other healthcare professionals, the effects of the ACA vary greatly based on the type of practice. For instance, new policies have increased the incidence of inappropriate ambulance use, thus affecting ambulance response times (Courtemanche et al., 2019). Considering this, current policies’ effects on practice include both improvements and challenges.

The differences between physicians or other healthcare providers in fee-for-service and value-based systems are rather pronounced in terms of reimbursement practices. If value-based reimbursement methodologies are implemented, providers’ work is evaluated concerning patient outcomes, which may include the rates of complications, hospital readmissions, unnecessary treatments, customer feedback, and so on (Zywiel et al., 2017). In contrast, in fee-for-service systems, the volume of services presents the basis for fee calculation. The outcomes and relevance of procedures are not considered, which may increase the ordering of unnecessary tests by physicians.

Changes to the principle of reimbursement may cause improvements in terms of healthcare providers’ professional behaviors, which explains the potential of value-based systems for healthcare in the U.S. Particularly, practitioners in value-based systems are motivated to rely on the principles of patient-centeredness in the selection of medical tests and interprofessional communication. The changing payment calculation principle requires significant improvements in practitioners’ behaviors and decisions regarding treatment and care. For instance, in value-based systems, physicians do not benefit from unnecessary medical and diagnostic interventions, which requires them to select treatment options more carefully and give preference to the most cost-effective options available. However, the identification of low-value interventions requires substantial research and is not possible without confident leaders with vast clinical experiences (Zywiel et al., 2017). Value-based systems’ emphasis on quality rather than quantity also promotes the need for effective team communication and conflict resolution skills in physicians (Sterbenz & Chung, 2017). Thus, the peculiarities of value-based contracts change physicians’ key priorities when it comes to treatment.

Power-sharing in nurse-physician collaboration is of critical importance in terms of care quality and decision-making speed since it promotes the clear distribution of responsibility and prevents conflicts. In the healthcare system where I work, nurses and physicians engage in collaboration and work in teams to maximize positive outcomes for patients by ensuring the timely exchange of information about health improvement or deterioration. The power is distributed in a way to align each professional’s education-related strengths with their areas of responsibility. It involves entrusting disease management planning and relevant medical evaluations to physicians and enabling nurses to make decisions related to nursing care and psychological support rather than seeing nurses only as assistants. Based on my observations, patients tend to feel safer when they notice extensive collaboration between nurses and physicians. It can be assumed that clients begin to understand that nursing care extends far beyond following the doctor’s orders thoughtlessly. Thus, in the presence of adequate training, this approach to power-sharing has a positive impact on care quality and well-being, including psychological comfort.

Conclusion

In summary, value-based care can improve healthcare in the U.S. by reinforcing the need for interprofessional collaboration, cost-effective treatment plans, and the reduction of diagnostic waste. Current attempts to encourage a shift from fee-for-service systems have multiple effects on care, including the promotion of educational achievement among care providers and the development of better leadership skills in physicians. With that in mind, this approach to reimbursement deserves attention when it comes to large-scale quality improvement initiatives.

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References

Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of nurses. Online Journal of Issues in Nursing, 24(2). Web.

Courtemanche, C., Friedson, A. I., & Rees, D. I. (2019). Association of ambulance use in New York City with the implementation of the Patient Protection and Affordable Care Act. JAMA Network Open, 2(6), 1-9. Web.

Sterbenz, J. M., & Chung, K. C. (2017). The Affordable Care Act and its effects on physician leadership: A qualitative systematic review. Quality Management in Health Care, 26(4), 177-183. Web.

Zywiel, M. G., Liu, T. C., & Bozic, K. J. (2017). Value-based healthcare: The challenge of identifying and addressing low-value interventions. Clinical Orthopaedics and Related Research, 475(5), 1305-1308. Web.

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StudyCorgi. (2022, May 18). The Merits of Value-Based Care System. Retrieved from https://studycorgi.com/the-merits-of-value-based-care-system/

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StudyCorgi. 2022. "The Merits of Value-Based Care System." May 18, 2022. https://studycorgi.com/the-merits-of-value-based-care-system/.

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StudyCorgi. (2022) 'The Merits of Value-Based Care System'. 18 May.

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