peer 1 wk8

Volume versus Value-based insurance

Volume-based insurance design is similar to volume-based care. The provider is getting compensation based on the number of services provided. However, value-based reimbursement pays providers based on quality of care and patient outcomes. The rapid rise of healthcare led to the transition from volume-based insurance to value reimbursement. Value-based insurance discourages low-value services such as Implementing clinic nuance within value-based insurance prevents unnecessary testing – performing a cervical screening on a person who had a total hysterectomy or ordering a mammogram on a person who is 85 years old; unnecessary testing increases healthcare costs and wasteful spending. The Health Enhancement Program (HEP) is supported by the Affordable Care Act and Medicare Advantage program. They encourage high-value services that will reduce costs related to nonadherence, decrease health disparities, and improve health efficiency without compromising the quality of care. Providers were getting paid for services, but patients were receiving poor healthcare. Switching to value-based insurance ensured providers would deliver evidence-based health services to all patients, promoting effective, quality outcomes (Nash, 2019).

Insurers and purchasers choosing value base

Patients and insurers are choosing value bases to eliminate financial barriers and complex health complications. Employers use value-based plan designs to help make it convenient and manageable for patients to get quality care.  Supporters of value-based insurance (Employers) are also offering incentives like gift cards based on annual examination reports to promote healthier people and lower yearly health costs. Consumers are provided plan options to ensure that insurance meets their health needs and that they get value for their premiums. For example, a healthy 20-year-old may choose health insurance with a higher deductible, paying a lower premium. He or she may only go to the doctor for sinus sick visits and preventative services. Employers also offer health savings plans (HSA) for employees who choose a higher deductible plan to assist with copay and deductibles.  But, a person with a diagnosis of diabetes, CAD, or cancer patient will benefit from a lower co-pay, deductible policy. Providing individuals with options increases the number of the population who are insured. Utilizing value base insurance aims to improve quality of life while lowering the cost of healthcare by empowering choice

 

Questionnaire case study

Mr. Arnold should outline and inform new employees of the advantages of the HEP design. If Mr. Arnold had initially been in the HEP plan, he would have been diagnosed with COPD through preventative testing and a CT scan due to his history of being a long-term smoker. Early diagnosis can prevent complications. He can use his situation to educate new hires about how undiagnosed COPD can result in irreversible intestinal lung damage, leading to respiratory complications.

Joseph’s perception is incorrect. Over time, the plan will reduce healthcare costs. By participating in value-based insurance, preventative screening will promote early treatment and reduce complications. If one does not join in value-based insurance, the participants may not know about being a diabetic, CAD, or colon cancer until complications occur. Managing complex diseases and providing cancer treatment is costly. 

Mr. Arnold should tell Harry that preventative screening, such as diabetic foot examinations, routine eye examinations, and continuous monitoring of A1C, can prevent complications such as the risk for foot ulceration, utilizing statin therapy to prevent CAD, and A1C education to avoid organ damage such as kidney disease.

The positive effect of preventative services on the HEP plan’s profitability. Utilizing value-based plans among risk populations within state employees can improve the quality of care at little to no cost. Preventative screening reduces long-term costs by promoting early detection and short-term treatment. Copay is more impactful than deductible premiums within complex populations (Reynolds et al., 2022)

 

Value-base perspective

Value-based reimbursement holds providers responsible for delivering high-quality services. Providers will more likely adhere to evidence-based practices to ensure higher reimbursement. Who wants to work for free? Because providers know that revenue will be removed, they will provide ultimate care. Patients with complex diseases such as diabetes will improve medication adherence due to VBID reducing patient out-of-pocket expenses.

Advantages and disadvantages

Value base is the best design plan to improve healthcare abroad and quality of life. One advantage is that the consumer cost is based on the type and services provided, not the clinic value; therefore, patients are not overcharged. Patients are paying for quality care and preventative services through value-based insurance, promoting screening free of charge to negligible cost. Low cost encourages patients who cannot afford to get preventative to buy into value-based insurance to prevent complications.

Some disadvantages are that people enrolled in plans with a deductible must pay the deductible before services. Providers may think value-based insurance is time-consuming. Comprehensive training to ensure evidence-based practice can be costly.

 

Reference

Nash, D. (2019). The healthcare quality book: Vision, strategy, and tools, fourth edition (aupha/hap book) (4th ed.). Health Administration Press.

Reynolds, T., Yu, A., Rascati, K., & Godley, P. (2022). CO28 Impact of Value-Based Insurance Design on Medication Adherence in Patients with Asthma and/or COPD in an Employee Health Plan: An Interrupted Time Series Analysis. Value in Health25(7), S309. https://doi.org/10.1016/j.jval.2022.04.126

 

Wang, S., Weyer, G., Duru, O. K., Gabbay, R. A., & Huang, E. S. (2022). Can Alternative Payment Models And Value-Based Insurance Design Alter The Course Of Diabetes In The United States? Health Affairs (Project Hope)41(7), 980–984. https://doi-org.proxy.library.maryville.edu/10.1377/hlthaff.2022.00235

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