Value Based Purchasing


Every so often a change comes about, either by force or necessity, that helps something or someone to be better.  That is exactly what is happening to the healthcare industry right now, and there is a lot of buzz, both in favor and opposed to changes being demanded by the government, specifically, CMS (Centers for Medicare and Medicaid Services).  The traditional fee-for-service is being replaced by value based purchasing, which makes providers accountable for their care of patients.  One of the big questions is: why would such a huge change be required without much time or preparation?


Employers Want More Bang for the Buck


One of the groups that has a lot invested in the healthcare market is the employers of all the people seeking care.  They pay a significant amount each year to make sure that their employees are healthy, get healthy after being sick or help them when they have chronic conditions.  They don’t want to being paying for unnecessary testing or exams, they don’t want to have an employee missing due to several redundant appointments and they don’t want to see their costs going up each year without seeing a betterment to the health of their employees. 


Obviously, there are going to be issues and accidents that will severely affect an employee, but that is more the exception to the rule rather than the general rule of thumb.  But, why shouldn’t an employer demand that preventative care, better results from current care and more solutions for chronically ill be more the norm within healthcare? 


Compare and Choose


If you have ever bought a big ticket item, like a car or a computer, there is usually a little bit of research that goes into it.  Years ago, before the internet, the research might have been kicking a few tires, or comparing stats with a customer service rep at a store.  We take for granted the ability we now have to review hundreds of customer reviews, experts’ evaluations and data to back it all up.  But, we haven’t applied this to our doctors, hospitals and other healthcare facilities.  This may partially be due to the protectiveness that the industry holds because healthcare isn’t as easy as giving a pill to cure someone. 


This kind of mentality is changing, though, towards one with more transparency, one with patient’s input, and one with evaluations of an organization as a whole.  The professionals are held more accountable for things that are in their control, and allows patients to be more selective in who they choose for help.  There is nothing wrong with rewarding well-performing healthcare facilities and doctors with more business. 


Continuous Care


It is one thing to be put on a new prescription or add exercise to your routine.  It is another thing completely to have several new medications to take, new routines that must be followed and a new schedule for your life.  Some patients are faced with life-changing events that they may not fully understand when they are released from a hospital or care facility.  Being left out to dry, whether in extreme conditions of change or not, can lead to many disastrous results for the patient.  Healthcare organizations are working hard to reduce the number of readmissions into the hospitals, and one way has been to make sure that care is happening beyond the exit sign. 


Healthcare advocates have been a helpful addition to the roster of people providing care.  They follow up with patients not only to see if they are doing well, but to see if they have questions, to explain instructions that might have been glossed over, and even to help set up appointments if necessary.  This extra personal care goes a long way towards making sure that a patient doesn’t feel as if they are left to their own devices, and ensures that they also feel as if they have someone they can turn to, especially one that doesn’t require an office visit. 


Facility Flexibility and Adaptability


Most attention is directed towards patients and patient care, but healthcare facilities are on the line to provide that care and are accountable when things go wrong.  With value based purchasing standards being utilized and reimbursements from CMS being penalized when things do go wrong, hospitals and other resource sights want some say in how they are assessed.  Not every day is the same, nor is every patient with a cold have the same symptoms and treatments.  For these reasons and a host of others, organizations need the flexibility to set some of their standards and scale them to the needs or demands at that moment. 


Large facilities with lots of means to draw from have a much easier time implementing value based purchasing into their daily routines, and thus are able to find a cost-cutting measure to help them thrive.  Smaller facilities that work on a tight budget and may not have as many resources are at a higher likelihood of being penalized for not finding ways to save money.  There is no cookie-cutter system that will fit every organization’s needs, so having some negotiation power is what many of the smaller groups are looking for. 


Value based purchasing is a means to an end for better care at a lower cost for everyone involved.  This doesn’t mean that the system has all the kinks worked out or that changes might be required to the standards over time, but it moves the healthcare community out of an old-fashion way of treating patients and running a business towards a more patient-centered way of care that makes sure to eliminate waste and inefficiencies.  Everyone benefits, and as more organizations get on board, these benefits will be seen more openly.

Many voices have expressed their frustration when it comes to the cost of healthcare. These voices aren’t just those of patients receiving bills, but also health insurance companies and employers who are paying out each year to insure their employees. One of the loudest voices comes from the CMS or Centers for Medicare and Medicaid Services, which helps cover many Americans with their healthcare needs. To help find out why costs were rising, but the level of care was not, Medicare sought out a new way of working with healthcare providers and developed what is known as the Medicare Value-base Purchasing program to incentivize healthcare organizations to do two simple things: improve care and cut overall costs.