Policies and payment systems associated with value-based healthcare are proving to be both beneficial and challenging for physical therapists throughout the nation.

Value Based Health Care

The act of aligning the processes and incentives in value-based healthcare among physical therapists is a challenging endeavor. This is proving to be even more true now that the general landscape associated with value-based healthcare is evolving.

This is due to the program known as the Next Generation Accountable Care Organization, which is directly sponsored by the federal-based Medicare and Medicaid Services program known as “CMS”.

When combining patients from Medicaid, United HealthCare, and those under Aetna, Cigna, and Humana Health, there is approximately 354,000 individuals to be affected by the changes that are currently occurring in value-based healthcare.

A large percentage of these individuals utilize physical therapy programs.

All the physical therapists that are currently involved in value-based care have the desire to assist their patients and act in their best interests. Unfortunately, many of the requirements that are now coming into focus with the evolving landscape of value-based care requires the assistance of other medical professionals in the industry.

In fact, achieving results will take a comprehensive multidisciplinary team of people that may include medical doctors, nurses, case workers, and/or those that specialize in social work.

The next issue that is detrimentally impacting physical therapists in the value-based healthcare system is that it has not completely transferred.

There are still instances where fee-for-service is in place. This means that insurance companies are not paying as quickly because it is not all streamlined. The payment models must be aligned to one or the other – not both. Therefore, the payment model must transition over to a value-based model as quickly as possible.

Unfortunately, it does not appear as if that will happen anytime soon.

The payment models should include alternate payment models that are completely separate from those involving the arrangements set forth by the ACO.

One type of alternate payment model is bundled payments. This is where physical therapists and other types of healthcare providers come together and create bundles designed for certain types of medical conditions, diseases, and even medical procedures.

Not only would this help solidify the expenses associated with these issues, but, it would help medical providers work together – as a team – to ensure that each patient receives the personalized care that they need to recovery appropriately.

The purpose and intent of value-based care is to make certain that patient outcomes are positive. There is no “one size fits all” when it comes to health care. Providers must collaborate and create individualized care plans that will truly benefit their patients.

They should not be distracted by payment models, issues with insurance coverage, and processes that are similar in nature.

Additionally, information should be created that specifically outlines the types of care and payment models that are available. If these situations are addressed and all physical therapists have a solid understanding of what is happening, the patients will benefit in innumerable ways.

Resources:
https://www.healthcare-informatics.com/article/value-based-care/landscape-tilt
http://ihealthtran.hs-sites.com/managing-your-entire-population-to-avoid-value-based-failure
https://www.healthcaredive.com/news/payers-moving-to-value-based-care-faster-than-expected/525900/