BIP Spring 2025

Voices

Value-based care requires a team effort Patients, providers and insurers can work together to improve healthcare efficiency. By Scott M. Stevens

Value-based healthcare is gaining traction across the country as a way to deliver and pay for care. Its goal is ambitious: to lower costs, improve care quality and achieve better outcomes. Unlike many past strategies aimed at reducing healthcare costs, value-based healthcare tackles both the supply and demand sides of the equation. The ultimate goal of value based health plans, like all healthcare cost management efforts over the years, is to lower costs and improve quality. Achieving this requires changes to both how care is delivered and how it’s paid for. Patients and healthcare providers must shift away from traditional patterns and reim bursement models, adopting more efficient approaches for better outcomes. Let’s take a closer look at how each of these key stakeholders is adapting to value-based healthcare. Patients To achieve the goals of value based healthcare, patients must embrace and prioritize well ness and prevention. Wellness includes maintaining a healthy diet, exercising regularly, manag ing stress, getting enough sleep and staying hydrated. Prevention is equally essential.

spend nearing $4 trillion annually — about a third of the GDP — reducing these costs could have a massive economic impact. Patients should also be re minded that the Affordable Care Act mandates that insurance providers cover preventive care at 100%, with no copays, deduct ibles or coinsurance for services categorized as preventive. Value-based health plans take this approach further by eliminating many financial bar riers to care. For example, these plans might feature no deductible, $0 copays for primary care, $25 copays for specialists and lower out-of-pocket costs for hospital care, imaging and outpatient surgeries. These plans are often paired with Accountable Care Orga nizations (ACOs) and typically require patients to select a pri mary care physician to coor dinate and authorize specialty and other types of care. This structure is designed to enhance efficiency, lower costs and im prove health outcomes. Providers Aligning incentives between providers and patients has always been a goal of healthcare reform. The challenge lies in the tra ditional fee-for-service model,

Scott M. Stevens, RHU, CDHC, is an employee benefits broker and consultant who has worked with

TIP: Unlike traditional copay or high deductible plans, value based plans often reduce or eliminate cost-sharing requirements.

thousands of organizations to implement alternative health insurance funding solutions, creative strategies and employee educational tracts for 37 years. He has been involved with NABIP for more than 35 years. It requires scheduling routine annual physicals and undergo ing recommended screenings and treatments, such as blood tests, colonoscopies, vaccinations, mammograms and pap smears. It’s far easier — and more cost effective — to prevent chronic illnesses than to treat them later. Experts estimate that up to 75% of healthcare expenses are tied to preventable chronic ill nesses. With the U.S. healthcare

22 bip magazine Spring 2025