What are the hurdles to overcome in the transition from fee-for-service to value-based reimbursement? Is Value Based Care here to stay? Learn more from this slide-share on the differences between Value Based Care and Fee For Service.

1. VALUE
BASED
CARE
BY TXCIN
FEE FOR
SERVICE
VS

2. The healthcare industry is
experiencing a transformation
involving reimbursement payment
models. The conventional fee-for-
service (FFS) reimbursement model is
slowly being replaced by the concept
of value-based care, a reimbursement
methodology that challenges the
“volume-based care” associated with
fee-for-service and encourages
healthcare providers to deliver the
best quality care at the most
reasonable cost, improving the overall
value of care.

3. WHAT IS
FEE FOR
SERVICE?
Fee-for service (FFS) is healthcare’s
most traditional payment model
where physicians and healthcare
providers are reimbursed by
insurance companies and
government agencies (third-party
payers) based on the number of
services they provide, or the number
of procedures they order. Payments
are unbundled and paid for
separately, so every time patients
have a doctor’s appointment, a
surgical consultation, or a hospital
stay, these third-party payers are
billed for each visit, test, procedure,
and treatment provided, even though
some of these may not be needed, or
supported by evidence-based data.

4. WHAT IS
VALUE
BASED
CARE?
Value-based care is a philosophy of
healthcare realized when clinicians
intentionally consider the quality of
care provided, and the overall
outcomes of that care, in relation to
cost-efficiency. In the value-based care
model doctors and specialists consider
“best practices” when treating patients,
since they are reimbursed for the
quality and efficiency of care they
provide. Value-based care models
encourage a “holistic,” team approach
to care, requiring coordination and
communication between physicians
across specialties. When successful,
physician entity groups receive
incentive payments for providing
better care for individuals at a lower
cost.

5. TYPES OF
VALUE-BASED
PAYMENT
MODELS
Quality and efficiency are the goal of every
value-based payment model. There are
four conceptual “templates” for value-
based care, and each consists of multiple
models specific to specialty, episode, and
patient population:

6. M
O
D
E
L
S
Pay-for-Coordination: a primary care
physician leads and coordinates care
between multiple providers and specialists
to manage a unified care plan for patients
and to ensure efficiency and quality; e.g., the
Patient-centered Medical Homes (PCMH)
model.
Pay-for-Performance (P4P): healthcare
providers are incentivized to meet certain
quality and efficiency benchmark measures.
Physician reimbursements are directly
related to achieving these performance
measures; e.g., the Hospital Readmission
Reduction (HRR) program and the Skilled
Nursing Facility Value-based Program
(SNFVBP)

7. M
O
D
E
L
S
Bundled Payment or Episode-of-Care Payment:
this model encourages quality and efficiency
because healthcare providers are reimbursed
with a set amount of money to pay for a
specific episode of care, such as a hip
replacement, and any complications. Providers
keep any realized net savings; e.g., the newly
launched Bundled Payments for Care
Improvement—Advanced (BPCI--Advanced)
model and the Comprehensive Care for Joint
Replacement (CJR) model.
Shared Savings Programs (Upside and
Downside): physicians form entity groups and
provide population health management.
Quality and efficiency are achieved through
coordinated, team care and any realized net
savings are given back to the provider: e.g.,
Accountable Care Organizations (ACOs).

8. HOW IS VALUE-
BASED CARE
DIFFERENT FROM
FEE-FOR-SERVICE?

9. "The value-based model of healthcare
shifts the emphasis of care from simply
reimbursing clinicians on tests and
services ordered to rewarding physicians
for providing appropriate, coordinated
care that keeps patient populations
healthy. Value-based care programs are
designed to drive down healthcare costs
and to improve patient care and
population health, by financially
rewarding healthcare providers for
considering overall patient care, cost-
efficiency, and patient outcomes."
http://www.insight-txcin.org/post/value-based-care-vs-fee-for-service

10. In spite of the inevitable shift from fee-
for-service reimbursement to value-
based care reimbursement, Paul
Ginsberg, PhD, former Norman Topping
Chair in Medicine and Public Policy at
the Sol Price School of Policy at the
University of Southern California,
suggests that “this transition does not
mark the ‘death’ of FFS.” He points out
that the “FFS chassis is present in the
shared savings models,” and he goes on
to assert that “the role of FFS is merely
being de-emphasized.”

11. There are still hurdles to overcome in
the transition from fee-for-service to
value-based reimbursement, but value-
based care is here to stay, establishing
its foothold in the healthcare industry,
incentivizing cost-efficiency and quality,
and creating structures that reward
physicians for coordinated, appropriate,
and effective care.

12. Want
More?
http://www.insight-
txcin.org/post/value-based-
care-vs-fee-for-service

13. ABOUT
TXCIN
North Texas Clinically
Integrated Network, Inc. (dba
TXCIN) is a non-profit ACO
that began in late 2014. A
small group of independent
physicians aligned to initiate
clinical integration and value-
based contracting. Partnering
with RevelationMD and its
state-of-the art information
platform, TXCIN has become
the largest independent
network of physicians in North
Texas.