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What Every Medicare Patient Should Know About Value-Based Care

What Every Medicare Patient Should Know About Value-Based Care

July 29, 2024

July 29, 2024

By Blake Farmer, Head of Content

By Blake Farmer, Head of Content

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Patients may not even know they're part of a value-based care arrangement, but they should experience more attentive care that's focused on keeping them well.

Take a look at any itemized hospital bill, and it’s clear that patients — at least those who can pay — are incredibly valuable to the healthcare system. Each installment of KFF's Bill of the Month series is one more piece of evidence.

But how valuable is a patient’s health?

“Healthcare is no longer about healing. It is about keeping patients alive by treating them as much as we can and as often as we can,” says Wellvana co-founder and former hospital entrepreneur Charlie Martin.

His one-time colleague and fellow healthcare investor, the late Clayton McWhorter, shared Martin’s souring view on fee-for-service medicine.

“I sort of believe we have a system that we don't want you to get well nor die, because either way we lose a customer," McWhorter said near the end of his life.

Said less brazenly, our healthcare system was not designed for health.

Wellvana is designed to change that.

Change comes by way of value-based care — a term that means very little to most patients (and even some physicians). Put simply, it’s quality over quantity. And it's a national priority.

The Centers for Medicare and Medicaid Services remains committed to a goal to have all Medicare patients in a value-based care arrangement by 2030.

The shift to prioritizing high-value care may feel different and even unsettling. But it can go a long way if Medicare patients understand why they’re being asked to do things a bit differently.

Here’s what to expect:

Your doctor will push harder to see you every year, even when you’re not sick. They’re not trying to squeeze an extra co-pay out of you or order a battery of unnecessary tests to bill you for (in fact, there should be no cost). Value-based care focuses on prevention rather than treating sickness. That means seeing the doctor for a Medicare Annual Wellness Visit.

Think of your primary care provider as the quarterback of “Team Healthy You.” You may have a specialist managing your heart disease and another specialist managing your COPD, but your doctor still needs to be aware of all the healthcare you’re receiving to tie it all together and reduce redundancies.

Expect more support from an experienced care team. Doctors transitioning to value-based care, at least those aligned with Wellvana, rely on Foundational Care™. Experienced nurses support patients between office visits and after hospitalizations. Patients never see a bill for this service. Foundational Care helps patients navigate the system and stay well, driving down hospitalizations and medical expenses in the process.

Data drives decisions, and that’s a good thing. In the past, primary care physicians had to rely solely on their training and experience to make complex decisions about a patient’s care. Now they can connect the dots using large databases and a patient’s individual medical record. Wellvana's Clarity™ tool helps doctors essentially predict who may need a more personalized approach. The data allows them to be more proactive and double down on prevention.

The incentive is to keep you well, which keeps costs low for everyone. Healthcare isn't free with Medicare. Co-pays and deductibles are still a thing. But in these value-based arrangements, doctors are rewarded for keeping patients well and out of the hospital — where out-of-pocket expenses add up quickly. That means ensuring patients know they can call their doctor or care manager before going to the ER if it's not a true emergency. Your primary care physician could see you quicker than the ER can and is unlikely to leave you with a hefty bill.

There will be a test (a survey actually). Feedback is critical to delivering more valuable care. Patients with a value-based provider can expect at least two surveys a year from the federal government. And your doctor’s all-important Medicare Care Compare star rating is largely based on this feedback. So answer honestly and know that it will make a difference.

Value-based care doesn’t have to be complicated. It’s local doctors practicing medicine the way they always wanted to, focused on keeping patients healthy rather than seeing them only when they’re sick.

When working as intended, value-based care should save money for you as a patient and a taxpayer and help restore trust in the U.S. healthcare system.


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