When you’re at the doctor’s office, you might not be thinking about the payment agreement between your health insurance company (which can also be referred to as a payer) and the providers in its network. These agreements are usually based on the services your doctor provides you, such as tests. However, this fee-for-service structure does not have a direct financial tie to the quality of your health outcomes. It defines how health care providers are paid by health insurance companies for each individual service you receive.
In the past, when you visited a doctor’s office, your payments were based solely on the number and types of services provided by your doctor. Depending on the number of services, the payment was billed to doctors and health insurance companies by government agencies, health insurance companies or individuals. But over the past 10 years, there has been a shift in structure.
“Value-based care represents a shift from fee-for-service to fee-for-value,” says Andrew Pridgen, Virginia Premier’s director of value-based payments. “It represents more patient-centered care.”
So, what is value-based care, or fee-for-value? In short, this means providers and payers alike are incentivized to deliver the best quality care. The health care system began this shift to achieve something is referred to as the “quadruple aim,” or the improvement of health care in four categories: population health, patient engagement, cost reduction, and provider engagement. From an insurance company’s perspective, value-based agreements improve member outcomes, lower costs and increase provider satisfaction.
This value-based care transition has improved patient care and experience, as well as cost and data sharing for everyone involved, which was not always the case with the traditional fee-for-service structure. The focus on specific outcomes for patients leads to better managed care and a better quality of life. In turn, it means less costs for the provider and the payer. Regardless of the payer arrangement, you can be sure you are always receiving the best care from your doctor.
Virginia Premier’s network of providers is constantly growing to ensure we provide the best services to our members. If you are a provider and would like to join our network, sign up here.