Value-Based Care

Defining key terms:

  • Accountable Care: A person-centered care team takes responsibility for improving quality of care, care coordination and health outcomes for a defined group of individuals, to reduce care fragmentation and avoid unnecessary costs for individuals and the health system.
  • Care Coordination: The organization of an individual’s care across multiple health care providers. (
  • Integrated Care: An approach to coordinate health care services to better address an individual’s’ physical, mental, behavioral and social needs.
  • Person-Centered Care: Integrated health care services delivered in a setting and manner that is responsive to individuals and their goals, values and preferences, in a system that supports good provider–patient communication and empowers individuals receiving care and providers to make effective care plans together.
  • Value-Based Care: Designing care so that it focuses on quality, provider performance and the patient experience.

Additional Resources:

What is value-based care?

Value-based care is a term that Medicare, 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 into 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 nonmedical needs.

Learn more about what value-based care means for patients, providers and others via the Value-Based Care Spotlight.

What does value-based care look like for the patient?

In value-based care, health care providers recognize that each person is unique and can experience improved health outcomes through person-centered, coordinated care.

Individuals who receive value-based care — such as through an Innovation Center model or through another program in Medicare or Medicaid — may notice enhancements to their health care experience. For example, they might have:

  • An easier time navigating their care with the help of an assigned care coordinator who will contact them between medical visits to see how they are doing following a procedure, answer their questions, or problem-solve any issues they encounter following treatment.
  • Access to training or other educational resources about their health issue(s).
  • More options in how they receive care or how to communicate with their providers.
  • An opportunity to participate in a disease prevention program, such as for diabetes or heart disease.

And most importantly, individuals keep all their current Medicare benefits and continue to see any doctor who accepts Medicare.

How does value-based care help to treat the patient as a whole person?

Value-based care puts greater emphasis on integrated care, meaning health care providers work together to address a person’s physical, mental, behavioral and social needs. In this way, providers treat an individual as a whole person, rather than focusing on a specific health issue or disease. 

Health care teams spend time with individuals receiving value-based care to fully understand:

  • Potential obstacles or barriers to their care. Individuals might be asked about nonmedical factors that could have a direct impact on their well-being, such as access to reliable transportation or healthy food, relationships with family, and general living conditions.
  • Their health goals, so their treatment matches up with what they hope to achieve from their health care.

Providers practicing value-based care help make it more convenient and manageable for people to get care. Providers link individuals to additional resources to best support their health needs and goals, such as through referrals to local social services and programs.

Learn more about person-centered care.

What is the patient’s role in value-based care?

It is important that individuals are active partners with their doctors and other health care providers in their care. That means people receiving value-based care collaborate with their providers to design their treatment plans and they let their providers know if they have any questions or concerns.

Learn more about the patient's role in value-based care

What is the provider’s role in value-based care?

In value-based care, organizations of doctors, hospitals and other health care providers commit to delivering a high standard of care. As part of their participation in Innovation Center models, health providers aim to reduce health care fragmentation and are evaluated on their quality of care and individual health outcomes. The Innovation Center provides them tools to support delivery of high-quality, coordinated, efficient care to help them succeed.

Learn more about accountable care.

Does value-based care address health equity?

Health equity is achieved when everyone has a fair and just opportunity to attain their optimal health. Value-based care advances health equity by:

  • Putting focus — and having a measurable impact — on the health outcomes of every person, including those from underserved populations.
  • Encouraging health care providers to screen for social needs and work with individuals to develop personalized treatment plans that can address each person’s unique needs — such as connecting them to a local food bank, engaging with interpreter services, or arranging transportation or other accommodations.
  • Requiring health care providers to monitor and track outcomes across populations to assess for disparities and intervene as necessary to help close gaps in access or care.
  • Engaging with providers who have historically worked in underserved communities and providing necessary resources and supports to meet this health equity goal.

Learn more about health equity.

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