The Affordable Care Act of 2010 changed the way the healthcare service model was operated and delivered in the past bringing in changes that shifted the focus from a fee-for-service model to a value-based care model. The changes that were introduced in care objectives were based on three parameters
- A shift from volumes to the value
- Introduce new models to improve the care delivery
- System-wide improvement for an overall efficiency
The shift from fee to a value-based care model has changed the healthcare reimbursement model significantly and these changes have affected both in-hospital and home care, thus bringing in holistic movement. These changes significantly release the pressure from the burgeoning problem of the rising costs of the healthcare sector.
Decrease in recurrence
Acute pains can turn chronic and progress over time and continuing unhealthy lifestyle practices like eating high-sodium fat and fast food without nutrition will make the matters worse.
Often our body sends the warning signs way ahead of an actual eventuality like a cardiac stroke that things are not right. Value-based care model focus on the opportunity at hand to holistically treat a patient when the problem is still at a nascent or manageable stage.
In a value-based model, the following methods are used to help patients manage their health without any incidental need to be admitted to a hospital:
When a patient visits a physician associated with Accountable Care Organizations or ACO, the family history and current conditions of the patient are thoroughly assessed. Assuming a patient complains of inability to breathe easily, the physician determines if he is overweight, has any family history of heart or organ failure conditions, is a habitual smoker, and checks on the quality of his diet.
Then the patient is signed up with a dietician who will teach them the importance of eating a high-fiber balanced diet that is local and seasonal to improve the absorption of essential nutrients that aid in the absorption and passage of oxygen in the blood. When the circulation of blood is at equilibrium, the body functions well.
The patient is also encouraged by the nurse manager to take their medication without any gaps and stick to a fitness program that will keep their body active and help them lose some weight. In their next visit, the patient’s condition improves, there are no episodes of shortness of breath, and any danger of the patient approaching an otherwise impending problem of CHF is averted.
In this manner through effective patient engagement, the value-based model has been able to avoid admission of patients into a hospital and even reduced the burden of healthcare costs.
Remote patient monitoring devices measure accurate physiological changes and relay this information with help of sensors and wireless connection with the portal of a telehealth nurse who is monitoring all the RPM devices in the program.
Any change in the physiological conditions of at-risk patients, like higher respiratory rate in COPD patients or abnormal blood pressure in heart conditions will alert the nurse. Immediately a connection is established with the patient or their family to warn them of any impending danger, and they are advised of precautionary measures to stabilize the patient.
Early detection helps RPM users by responding to the situation within a short time frame and avoiding admission. In this manner, lives can be saved and costs can be controlled.
Telehealth services can be used to improve the value of the care model that is serviced by a healthcare facility. Ambulatory patients can be connected without the need them commuting to a hospital and waiting their turn to be attended by a clinician or a nurse practitioner. Patient engagement and consultations can be carried out through telehealth models thereby increasing positive patient outcomes and enriching experience.
With a patient-driven grouping model or PDGM, the volume of therapies is reduced, and an increase in the value of therapy is included. It is shifting from the earlier volume-based payment model to one that focuses on a patient’s needs, characteristics of the medical conditions, needs, and goals specific to the patient. In this manner, it is a value-based model and is unique to each patient.
A value-based care model is a patient-driven approach that will remove the anomalies of payment models while focusing on the overall improvement of the health of a patient and the community in general. It will also help reduce healthcare costs.