Value-based care (VBC) is a healthcare delivery structure where providers are graded and reimbursed for safe, efficient, high-quality care rather than the volume and complexity of services performed. A value-based approach prioritizes:
Adherence to evidence-based guidelines
Understanding patient goals
Promoting cost-effectiveness
Improving population health
Enhancing patient experiences
Providing equitable access to care
The American Academy of Family Physicians captures the elements of VBC in an equation:
Value = (Quality x Patient Experience) ÷ Cost
In the early 2000s, a growing body of research showed that fee-for-service reimbursement models, where providers are paid based on the volume of service they claim to deliver, were contributing to rising healthcare costs, inconsistent quality outcomes and financial unpredictability for providers and healthcare organizations.
A landmark series of reports from the Institute of Medicine (now known as the National Academy of Medicine) called for a “STEEP” approach to healthcare: safe, timely, efficient, equitable, patient-centered care – this concept became the framework for VBC (Value-Based Care). Federal programs like the Affordable Care Act and Medicare’s Value-Based Purchasing Program accelerated the implementation of the VBC approach, with solutions such as bundled payments and quality metrics reporting.
VBC is now an integral component of both public and private payer structures, with a growing emphasis on interoperability, risk adjustment and health equity.
AAVBC’s framework for high-value healthcare delivery:
Value-Based Care provides the right care, to the right patient, at the right time, in the right setting, for the right reasons.
Providing medically necessary solutions that adhere to established guidelines, consider individual risks, and improve patient outcomes without incurring future complications or costs.
Every patient is different – VBC uses all available data to ensure care plans are tailored to patients' unique needs and circumstances.
Timely interventions have the greatest impact. In VBC, this means taking preventive steps before a condition develops, early intervention for identified conditions and delivering acute care when a condition advances.
In VBC, the choice of clinical setting for care delivery balances medical appropriateness with patient convenience and cost.
VBC is a mindful approach to healthcare, with a clear rationale for every clinical decision and an insistence on accountable, transparent care that builds trust between patient and provider.
