The Business Case: Pay-For-Value Contracting

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By now you’ve heard about pay-for-value, which rewards providers for quality of care, not quantity. In fact, Ohio’s governor has established “Transformation of Healthcare Goals” for the state of Ohio to drive a payment system to Primary Care Physicians that focuses on quality of care rather than quantity of care.

Pay-for-value holds a single provider accountable for that patient’s care, regardless of who actually delivers the service. Under a pay-for-value model, the accountable provider is incentivized to improve the patient’s overall health and cost outcomes, regardless of the number of services provided.

It could be as simple as ensuring a patient takes medication as prescribed or schedules their preventive care screenings and blood tests, even if that results in fewer office visits.

HERE’S HOW IT WORKS:

A patient is assigned to a single accountable provider; this is often, but not always, their primary care physician. The accountable provider directs their patient’s care to other providers for things like diagnostic and outpatient procedures, consultations and rehabilitation. But the primary care provider is accountable for the outcomes.

The provider is given the tools and training to easily access and evaluate each patient’s medical records for potential risk drivers, care opportunities, and utilization trends. And they are compensated for time spent on care coordination and planning. So providers are no longer faced with choosing healthier patients or higher compensation.

Infographic on providers vs nonparticipating providers

These better outcomes translate to lower costs, with a gross savings of $9.51 per attributed member per month.

Pay-for-value members also report greater satisfaction with access, communication and the amount of time spent with providers.

Pay-for-value is transforming the way we approach health care.

McGohan Brabender is your source for the latest, proven innovations that will improve health and lower costs, now and into the future. For more case studies and information to better manage your health care spend, visit www.mcgohanbrabender.com.

Good, Smart People Effectively Managing the Entire Health Care Dollar.

Download the ‘The Business Case: Pay-for-Value Contracting’

For 40 years, McGohan Brabender has been simplifying the delivery of health benefits by managing risk and reducing costs. We are passionate about what we do and have the tools and experience to guide you through the chaos of health benefits management.