Basics of Value-Based Care

An older woman and her female doctor sit at a table deep in discussion

Basics of Value-Based Care

Innovating care to quality

Medicare and Medicaid run pilot programs also called models, to help doctors and other health care providers deliver high quality care. These programs improve health care and the patient experience, for example, by making sure doctors talk to each other and coordinate around a patient’s care, and focus on the patient and see them as a whole person. These programs are often referred to as value-based care.

Understanding value-based care

Value-based care is a term that Medicare, Medicaid, doctors and other health care professionals sometimes use to describe health care that is designed to focus on quality of care, provider performance and the patient experience. The “value” in value-based care refers to what an individual values most.

In value-based care, doctors and other health care providers work together to manage a person's overall health, while considering an individual's personal health goals. For example, doctors might coordinate an individual's blood work so that they only need to go to the clinic once. This approach to care also can help people avoid the emergency department and keep them out of the hospital. 

The CMS Innovation Center runs pilot programs called "models" to determine the most effective approaches to this type of care. These models may improve health care, for example, by prompting doctors to:

  • Talk to each other and coordinate care across practices and appointments.
  • Focus on an individual receiving care as a whole person by helping them address their medical and non-medical needs. 

Aligning care to patient goals: Lamont’s story

Learn how Lamont’s primary care doctor took time to understand his goals and supported him via an Accountable Care Organization.

smiling woman stretching a band between her arms for physical activity and wellness while care provider watches and smiles

Patient role in value-based care

Every individual has a meaningful part to play in their health care – each person’s voice, concerns and health goals matter.

Introduction to Key Concepts

Key Concepts are brief introductions to topics that play a critical role in the CMS Innovation Center’s work. These have been trimmed of technical jargon and use everyday language to describe the concepts—including why you should care about them—and, where possible, offer helpful links to resources for additional information. 

Key Concepts are a useful tool for anyone who wants to learn how the CMS Innovation Center is transforming our health care system to focus on quality over volume. 

Accountable Care and Accountable Care Organizations

In an accountable care relationship, doctors and other health care providers work with each other and their patients to manage their patients’ overall

Person-Centered Care

In a value-based health care system, doctors and other health care providers deliver high-quality care using a person-centered care approach. This differs from a traditional fee-for-service system where patients get…

Page Last Modified:
01/23/2024 01:01 PM