Empowering physicians to provide quality care that enhances outcomes and effectively manages costs is the hallmark of the value-based care (VBC) model. While many health care policy experts agree that fee-for-service (FFS) medicine is wasteful and outmoded, making the switch to a VBC model can be challenging. Let’s look at what physicians need to successfully transition to VBC and how agilon health can help make the shift from volume to value.
The Statistics of Value-Based Care in 2023
While fee-for-service is still widely used, the value-based care model is gaining traction. According to the Health Care Payment Learning & Action Network’s (LAN) annual measurement of participation in alternative payment models, about 60% of health care payments in 2020 included some form of quality and value component. That number is up from 53% in 2017 and 11% in 2012.
In addition, the 2022 American Academy of Family Physicians (AAFP) value-based care survey reports that 49% of responding practices said they are participating in some form of value-based payment, and 18% are developing capabilities to adopt this payment model.
Value-Based Care Trends
The push to find alternatives to the FFS model has largely been driven by the federal government through the Medicare Shared Savings Program and the Centers for Medicare & Medicaid Innovation Center (CMMI). Established in 2010 as part of the Affordable Care Act, CMMI is working on payment models that improve care and lower costs for Medicare and Medicaid patients.
The COVID-19 pandemic has also had an impact on how practices view value-based payment models. When patient volumes dropped in early 2020—especially for primary care—payments fell dramatically for providers using the FFS model. Many practices recognized the need to explore more value-based models that could protect them from future drops in the number of patients seen.
What other factors are prompting the shift to VBC?
The rise in physician burnout is often cited as a reason for decreasing access to care and affecting patient safety and care quality, as well as increasing costs. Lack of control over how much time physicians get to spend with patients and burdensome administrative tasks are key causes of this burnout. VBC could reverse this trend. It enhances a physician’s work environment, giving them more time to work with patients and providing them with greater job satisfaction.
Moreover, as more physicians focus on the impact of social determinants of health, they recognize that value-based care is a proactive approach that can help vulnerable populations by reducing illness, promoting wellness, and lowering costs.
The Rationale for Implementing Value-Based Care
The Deloitte 2020 Survey of U.S. Physicians revealed that more than 70% of physicians recognize their role in managing costs but that they don’t have the tools to do it.
To make a successful move to VBC, physicians need to be on board with the idea and they need to have access to the proper resources.
At agilon health, we partner with community-based physician groups and eliminate obstacles through the expertise of our people, our unified platform, our processes—seamlessly integrated with the practice— and our capital. We empower primary care physicians to deliver the best patient care while managing costs and growing their practice.
Payor Engagement. In each community, agilon connects multiple payors, patients, and physicians into one platform to create a single experience for patients and physicians.
Data Integration. Physicians who partner with agilon health find that data collection and analysis become easier with the agilon platform, which collects, extracts, and shares financial, clinical, and social determinants data.
Clinical Programs. Using patient data and local care delivery successes, agilon and partner physicians work together to develop action plans that can be shared on the platform. In this way, physicians benefit from collective lessons learned.
Quality. The platform provides ways for physician partners to provide better care, expand access, reduce costs, and improve patient relationships.
Education and Communication. Physician partners are equipped with accurate information about Medicare, so they then can educate their patients and connect them with the appropriate resources to evaluate their Medicare coverage options.
Performance Analytics. Providers can access peer-to-peer performance comparisons on care at the physician, population, and network levels. In addition, quality and cost dashboards are consistently updated, allowing physicians to share information on best practices.
Financial Management and Contracting Model. Physicians who partner with agilon health benefit from a full-risk, total-care model. agilon contracts with insurers in all regions it serves, making agilon the primary risk-taking entity responsible for the care that its physician networks provide to Medicare Advantage patients. That means physicians can count on a stable monthly payment based on the expected care patients will receive. Higher payments are made for patients who have more extensive medical histories.
Transitioning to Value-Based Care with agilon health
The traditional FFS model rewards physicians for focusing narrowly on one unit of care rather than influencing health behaviors, overall care, and cost management. When primary-care physicians are empowered to manage the outcomes and total health needs of Medicare patients, all stakeholders benefit.
Learn more about how agilon health can empower your practice to achieve a sustainable and successful future.