All of us want our doctors to actually care about our health, not to just fill their patient quota for the day. Well, the government wants that too, for their own reasons of course. So, what exactly is Medicare’s value-based care model and how are Medicare plans adopting it?

In short, value-based care is the present and future business model of Medicare. Mainly, it affects how providers get paid for the services they deliver, but it also brings a plethora of great benefits for Medicare members. Not familiar with this major segment of health care reform and how it affects your clients’ coverage? Don’t worry. We’ll fill you in!

What Is Value-Based Care?

Value-based care is a health care delivery model first adopted in 2011 by the Centers for Medicare & Medicaid Services. This model rewards Medicare physicians, hospitals, and other health care providers with incentive payments based on the quality of care they provide to Medicare members, not the number of members they see. According to CMS.gov, their value-based care programs support:

  • Better care for individuals
  • Better health for populations
  • Lower costs

So far, CMS has seven value-based care programs:

How Can This Help You Sell Medicare Plans?

At least all of the major Medicare Advantage carriers have started implementing value-based care initiatives of their own. This is an attractive move for many plans, because if the quality of their members’ care improves, so should their health. Improved member health generally translates to lower risk members and decreased costs for insurers.

As part of many Medicare plans’ value-based care initiatives, members often receive more benefits, such as wellness, care coordination, and transportation benefits!

As part of many Medicare plans’ value-based care initiatives, members often receive more benefits, such as wellness, care coordination, and transportation benefits. These are enticing perks that your clients could want and find valuable to have.

What Exactly Does Value-Based Care Look Like for Medicare Beneficiaries?

Value-based care related benefits tend to fall into four categories for Medicare members:

  • Risk management (wellness and prevention programs)
  • Care management (including care coordination programs)
  • Care accessibility (in home and in the community)
  • Socially beneficial (address social determinants of health)

You can probably think of a few different benefits that the Medicare Advantage carriers already within your portfolio offer, which fall into one or more of these categories. For example, quite a few carriers offer the SilverSneakers® or Silver&Fit® fitness program, 24/7 nurse health lines, and telehealth services. Some carriers also offer diabetes management services, home health care programs, and social visits. These types of benefits all promote value-based care.

MA Carriers Expand Their Value-Based Care Through Partnerships

Lately, Medicare carriers have been making strategic partnerships in order to deliver more value-based care services. For example, insurers have been bringing pharmacy benefit management companies in-house, as well as teaming up with local retailers to make retail healthcare clinics readily available to their members. They’ve also been partnering with health care providers themselves, and even further integrating with provider organizations.

You can learn more about some big-name carriers’ value-based care initiatives by clicking the links below:

What Can Beneficiaries Expect in the Future?

From what we’re seeing, Medicare members can expect even more providers and plans to adopt the value-based care model. Earlier in the year, CMS and the U.S. Department of Health & Human Services announced the CMS Primary Cares Initiative, which introduced a new set of value-based care payment models. And in September 2019, CMS Administrator, Seema Verma, called for hospitals to get on board with the Trump administration’s value-based approach to health care or expect smaller and smaller fee-for-service proceeds, according to one Modern Healthcare article. “Value-based payment under the Trump administration is the future,” said Verma. “So, make no mistake — if your business model is focused merely on increasing volume rather than improving health outcomes, coordinating care and cutting waste, you will not succeed under the new paradigm.”

In order to stay competitive, improve member outcomes, and lower their costs, we believe health providers and plans will continue to grow their value-based care initiatives.

In order to stay competitive, improve member outcomes, and lower their costs, we believe health providers and plans will continue to grow their value-based care initiatives. We’ll likely see more partnerships and integration between Medicare plans and providers, more retail health clinics, expanded telehealth and wellness services, and more utilization of members’ data to improve health outcomes.

● ● ●

We all want value for what we spend our time and hard-earned money on. Providers want it for treating their patients. The patients, and policyholders, want it for the care they’re receiving. Their health insurers want it for the risk they’re taking. And, you, a dedicated health insurance agent, likely wants it for the health plans and services you’re selling. If implemented correctly, value-based care could be something that satisfies us all and makes this model worth the change.