Incentives for Practitioners with Medicare and Medicaid Patients

Value-based programs provide financial incentives to healthcare practitioners providing care to Medicare and Medicaid patients.

What Is a Value-Based Care Model?

Value-based care models encourage primary care practitioners to provide quality care to their patients to help decrease hospitalizations and other higher cost healthcare. Sponsored by the Centers for Medicare and Medicaid Services, practitioners can receive financial incentives for implementing a value-based care model.

This system creates a win-win situation for primary care practitioners and patients. Medicare and Medicaid beneficiaries receive higher quality primary care to prevent the possibility of needing high-cost services such as emergency room visits or repeat hospital visits for the same condition more than once.  Meanwhile, primary care practitioners can earn more for delivery healthcare that actually helps patients and keeps healthcare costs down, as opposed to being paid more for delivering more healthcare services.

How VBC Models Keep Costs Down

Quality primary care helps keep the costs of healthcare down for Medicare and Medicaid patients. This is because quality primary care leads to more thorough healthcare as a preventative measure to chronic illnesses. For example, a patient with a chronic illness who does not receive quality primary care may find themselves hospitalized for their condition multiple times. This is because their primary care practitioner did not help implement preventative measures in the care that they received that could have helped them avoid hospitalizations.

Through a VBC model, primary care practitioners are rewarded for providing thorough care to patients that actually helped them either recover or manage their health. This incentivizes them to be more thorough and accurate with the healthcare services they provide. Without a VBC model, primary care practitioners earn more for providing more healthcare services, regardless of whether or not their services actually helped the patient.

Who Uses the Value-Based Care Model?

The VBC model is designed to incentivize practitioners across the healthcare industry and can be used by the following types of organizations:

• Accountable Care Organizations (ACOs)
• Provider Groups
• Post Acute Organizations
• Health Systems
• Hospitals
• Hospices and Palliative Care

In order to implement the value-based care model, these organizations and groups can utilize data analytics tools to review patient data in order to make informed decisions about the quality of their care. Analyzing data can help organizations determine where they can improve their care services and help them reach out to providers that can help them fill gaps in their care delivery model.

Using financial data tools can also be essential to organizations using the VBC model. Through a financial analysis, practitioners and organizations can determine the costs associated with the care they provide to create the greatest financial impact possible while still providing high quality care.

Incentives for Preventative Screenings

The value-based care model encourages healthcare professionals to conduct more preventative screenings that help patients discover serious or chronic illnesses before they become serious. Catching serious illness early allows patients to treat it earlier and avoid it becoming a larger, more serious health issue. For patients, it can often help them avoid hospitalizations, emergency room visits, and even major surgeries that could have been avoidable if they had discovered their condition sooner.

CMS provides incentives to healthcare professionals for preventative screenings provided to Medicare and Medicaid patients. This allows practitioners to earn more for their preventative screening services without increasing the cost to patients. It also encourages them to promote preventative screenings, as they will not lose out financially for providing less extensive health services to these patients.