Value-based healthcare aims to lower costs and improve outcomes by tying reimbursement to quality and service rather than just volume of services. It defines value as quality of care plus service divided by cost, rewarding providers for evidence-based, patient-centered care. The US government is transitioning Medicare payments from a fee-for-service to a value-based model where 30% of payments consider quality by 2018 and 50% by 2023.

1. VALUE-BASED HEALTHCARE
How does it affect me?

2. As healthcare becomes more consumer –driven, patients
and providers are interested in healthcare services with a
level of value.

3. As healthcare becomes more consumer –driven, patients
and providers are interested in healthcare services with a
level of value.
The goals of value-based healthcare are:
• Lower healthcare costs
• improve quality & outcomes

4. WHAT IS VALUE-BASED HEALTHCARE?

5. WHAT IS VALUE-BASED HEALTHCARE TO PATIENTS?
• Safe
• Appropriate
• Effective
• Enduring Results
• Reasonable Cost

6. WHAT IS VALUE-BASED HEALTHCARE TO PROVIDERS?
• Employing evidence-based
medicine
• Proven treatments &
techniques
• Take into account the
patient’s wishes and
preferences

7. MOVE FROM FEE-FOR-SERVICE (FFS)REIMBURSEMENT
Sylvia Matthews Burwell, US Secretary of Health and Human
Services, under president Barack Obama, announced that
Medicare payment in reform plans to more quickly move
healthcare from a fee-for-service system that rewards “volume”
to one that rewards “value.”
“ . . . Medicare, which covers 54 million elderly and disabled
Americans, will base 30 percent of its payments on quality and
safety metrics. By 2018, half of all Medicare payments will fall
under this new model.”
Let’s look at the value-based equation.

8. THE VALUE-BASED HEALTHCARE EQUATION
V
(VALUE)
=
Q
(QUALITY)
+ S
(SERVICE)
$
(COST)

9. Knowledge Check

10. Question
1
What is the result of balancing Quality &
Service/Cost?
a) Fee-for-Service reimbursement
b) Value-based healthcare
c) Managed care

11. Question
2
Who is the most important player in value-
based healthcare?
a) Payor
b) Patient
c) Provider

12. Question
3
The goals of value-based healthcare are?
a) Lower healthcare costs
b) Higher reimbursement rates
c) Improved quality and outcomes

13. Question
4
To the patient, value-based healthcare
means among other things that the care
received is safe, effective and at a
reasonable cost.
a) True
b) False

14. Question
5
To providers, value-based healthcare
takes into account the patient’s cares and
wishes, but the provider’s direction is
final.
a) True
b) False

15. SUMMARY
As healthcare reimbursement moves
toward supporting value-based care,
patients and providers will achieve
quality care at affordable rates to the
patient.