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.
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.