In the constantly evolving landscape of healthcare, two significant models of care have emerged as key strategies to manage cost while striving to improve patient outcomes: Managed Care, which rose to prominence in the 1990s, and today's Value-Based Care. With specific focus on Musculoskeletal (MSK) (Bone, Joint and Spine) care delivery in narrow networks, this blog post compares these two models, their evolution, and potential impact on healthcare.
Managed Care: A Look Back at the 90s
Managed care programs emerged as a response to rapidly increasing healthcare costs. Emphasizing cost control, these programs used structures like Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) to manage patient access to services and negotiate prices with providers. The capitation system, a hallmark of managed care, paid providers a set fee per patient, which aimed to discourage unnecessary services. However, this system also raised concerns about potential underuse of necessary care.
While managed care programs did encourage preventive care, critics often noted their restrictive nature. Patient choice was somewhat limited, and the model focused more on cost containment than on patient satisfaction or outcomes.
Value-Based Care: Today's Paradigm Shift
In contrast to managed care, value-based care strives to improve patient outcomes while still keeping an eye on costs. This model shifts from paying for volume (number of services) to value (quality of outcomes), encouraging providers to offer high-quality, efficient care.
The reimbursement model under value-based care includes pay-for-performance, bundled payments, and shared savings. In this model, capitation payments are adjusted based on quality metrics, rewarding providers for delivering high-quality, efficient care.
One significant aspect of value-based care is its strong emphasis on patient-centered care. Providers are encouraged to consider each patient's unique health circumstances, preferences, and values to improve their health status, satisfaction, and quality of life.
The Role of Data and Technology
In the 90s, healthcare data was primarily used for administrative purposes, but today, data analytics and health information technology are at the heart of value-based care. With tools like electronic health records, predictive modeling, and telehealth, providers can track patient outcomes, coordinate care, manage population health, and provide evidence-based care.
Impact on MSK (Bone, Joint and Spine) Care Delivery in Narrow Networks
In the sphere of orthopedic or MSK care delivery, the transition from managed care to value-based care has significant implications. Care coordination, interdisciplinary care teams, and a focus on chronic disease management are essential elements of value-based care.
Innovation in care delivery, such as telehealth and patient-centered medical homes, can greatly enhance access and improve outcomes in orthopedic or MSK care. This value-based approach is more likely to lead to comprehensive, high-quality care for patients in narrow networks, aligning the incentives of patients, providers, and payers for optimal results.
In conclusion, while both managed care and value-based care models aim to control healthcare costs, value-based care offers a more holistic, patient-centered approach, emphasizing quality and outcomes. In the realm of orthopedic or MSK care delivery, particularly in narrow networks, this evolution promises to shape a more patient-oriented and outcome-focused future.
MPOWERHealth is dedicated to empowering better healthcare through innovative solutions for specialty physicians, hospitals, and payors. Its services include integrated physician networks that support collaboration between musculoskeletal physicians to promote quality improvements; best-in-class intraoperative neuromonitoring and surgical assist services for physicians, hospitals, health systems and medical facilities; and bundled solutions for payors and employers that create direct access to the highest level of conservative bone, joint and spine care at a set cost. Headquartered in Addison, Texas, MPOWERHealth serves over 400 physicians, more than 40,000 patients annually and 300+ facilities in 24 states. For more information and to see the company's comprehensive service offerings, visit MPOWERHealth.