The U.S. spends almost double the amount of any other economically-similar country. But all that spending isn’t resulting in better health outcomes...
In fact, in a comparison of 11 countries of similar size and economic wealth, the U.S. ranks last in life expectancy.
We have significantly more chronic diseases, such as obesity, heart disease, and diabetes. We also spend more on expensive tests, procedures, and prescription medications. We also have a much higher rate of hospitalization and death from preventable diseases.
Value-based care efforts aim to change those dynamics.
What is Value-based Care?
Since 1965, our healthcare systems operated on a fee-for-service (FFS) model. Providers and facilities made money based on how much care they provided — like surgeries or office visits — but we didn’t tie those services to outcomes. We didn’t account for whether the care was medically necessary or the patient was healthier as a result.
The Affordable Care Act (ACA) of 2010 shifted the decades-long FFS model to a value-based care (VBC) model. The Centers for Medicare and Medicaid Services (CMS) introduced multiple (and continually evolving) programs to curb unnecessary healthcare costs and improve quality.
Care Coordination. Patients get the right care in the right place at the right time. Providers work together and share medical information to avoid care silos and duplicated services and tests. They encourage patients to get preventive care and use lower-cost options when appropriate. For example, sending patients to urgent care instead of an emergency room for non-life-threatening medical issues.
Risk Management. Providers and payers manage patients with the highest risks and prevent disease instead of just treating it. For example, providers and patients proactively manage chronic disease to avoid ER visits. There is more focus on preventive care to reduce the risk of developing chronic illnesses.
Quality Metrics. Healthcare providers get paid for achieving specific quality outcomes. For example, a provider must show that their diabetic patient’s A1c levels are under control because of their care. This is a significant shift from FFS (reimbursed for an office visit) to value-based care (reimbursed for the outcome of that visit).
How Will CMS’s New Expectations Impact Organizations?
By now, most organizations are familiar with value-based care. There are hundreds of Medicare Accountable Care Organizations (ACOs) covering millions of Medicare beneficiaries. Many commercial payers are also using VBC models for non-Medicare beneficiaries. The biggest challenge is moving toward VBC while still juggling all the costs and responsibilities (and the ingrained habits) of an FFS model. Medicare reimbursements are already subject to some VBC metrics (which will increase over time) so it’s important that organizations take the necessary steps to get there.
To succeed with VBC, healthcare facilities need:
Buy-in from everyone — administrators, physicians, and staff — on the importance of VBC
Language support plays a critical role in improving services and reducing the cost of caring for limited-English proficient (LEP) patients. These individuals make up about 8.5% of the U.S. population — more than 25 million people.
Numerous studies show that LEP patients are at much higher risk of negative health outcomes when they cannot understand information about their care or communicate effectively with providers. The challenges also extend to cultural barriers that prevent someone from getting proper care. Errors are more likely to occur during:
Informed consent about risks and benefits of specific types of care
Emergency department care
When errors happen, they cause significant patient harm and increase total care costs. Without access to a medically qualified interpreter, LEP patients have:
Translation & localization services for your website and other public-facing information
Transcreation services that go beyond just translating the specific words, but also address cultural factors that can influence meaning and interpretation
Be Prepared With GLOBO
GLOBO is a partner that can help you prepare for the shifts that are coming — and the ones that are already here. We offer a wide range of language support solutions to organizations that want to address health disparities and improve care.