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Once again, a shift is occurring in healthcare as value-based care begins to replace the fee-for-service model. This move allows nurses to take a proactive role in working toward more positive results.

What Is Value-Based Care?

Value-based care focuses on quality rather than volume. The old fee-for-service system pays providers for tests and procedures performed as well as the number of patients they manage. Each service is paid for separately, so incentives hinge on quantity not select choices that fit the patient. And there is limited to no consensus about the management of care among the provider, nurses and healthcare team.

With value-based care, providers receive payment for services that meet criteria such as using evidence-based medicine, increasing patient satisfaction, upgrading health information technology and incorporating data analytics for management strategies that can improve patient outcomes. Value-based care focuses on the triple aim of healthcare:

  1. Provide better patient care
  2. Improve the health for patient populations
  3. Reduce healthcare costs

How Does Value-based Care Help Patients?

Value-based care replaces the fractured method of putting patients through a barrage of costly and unnecessary tests and procedures. Reimbursements for value-based care are driven by data that determines best practices for boosting the likelihood of patients recovering from or living with their conditions. Additionally, healthcare organizations are rewarded for carrying out coordinated services that are comprehensive and beneficial to patients. Thus, value-based care is about cutting costs while providing first-rate care.

What Is the Role of Nurses in Value-based Care?

Nursing is evolving due to the incorporation of value-based healthcare. Nurses need to take a coordinated approach to patient care, so communication and collaboration among members of an interdisciplinary team are crucial to developing and streamlining a care plan for patients.

An integration of primary, specialty and acute care is essential for sharing electronic medical records (EMRs) and relevant patient information which may eliminate redundant care while lowering expenditures.

Another goal of value-based care is patient education. Nurses should instruct patients about healthy lifestyle choices and teach them about self-care so they can prevent a medical crisis in the future.

How Is Value-based Care Affecting Healthcare?

A national study commissioned by Change Healthcare and conducted by ORC International included 120 payers. The study revealed important insights about the impact of value-based care. According to the findings, value-based care is achieving the triple aim of healthcare. Here are key trends the study found:

  • Value-based care strategies are reducing medical costs, with savings that topped 5.6 percent on average. Almost a quarter of payers are saving in excess of 7.5 percent.
  • Approximately 80 percent of respondents reported improvements in care quality and 64 percent noted an improvement in provider relationships. Moreover, 73 percent saw improved patient engagement.
  • Value-based care is replacing fee-for-service faster than anticipated. Fee-for-service is now only 37.2 percent of healthcare reimbursements and is projected to fall below 26 percent by 2021.

A nurse’s priority is to stay vigilant about the well-being of his or her patients. Fee-for-service is time consuming and frustrating for patients and nurses, as well as costly for healthcare organizations. Value-based care alleviates the hardships patients and nurses may encounter by closing gaps in services. By promoting prevention, nurses can ensure a healthier patient population with fewer chronic medical conditions. Through value-based care, nurses can uphold their commitment to providing optimal healthcare.

Learn more about Mississippi College’s online RN to BSN program.


MedCity News: How Nursing Will Evolve Under Value-based Care Clinicians Can Lead the Shift to Value-based Care

Change Healthcare: Finding the Value in Value-based Care

HIT Consultant: The State of Value-based Care in 2018: 10 Key Trends to Know

Rev Cycle Intelligence: What Is Value-based Care, What It Means for Providers?

SearchHealthIT: Value-based Healthcare

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