The Impact of Managed Care on Value-Based Healthcare

A managed care organization (MCO) can add to the success of value-based care. Healthcare facilities are adopting MCOs to improve their patient outcomes while controlling the costs. What managed care organizations do in value-based care is use preventive health, population health management, and care coordination to manage patient care. They also coordinate between the various payers—including Medicare, Medicaid, and private employers—to provide comprehensive healthcare services. By focusing on patients with chronic or complicated conditions, MCOs help to reduce unnecessary medical expenses and improve overall health outcomes.

Value-Based Care Models

In value-based care models, healthcare providers are incentivized by the payers to achieve specific health outcomes. The Bundled Payments for Care Improvement (BPCI) Advanced is a program that does just that. Payers can manage how payments are made and decide who is in their network. That helps to ensure cost-effective and high-quality care. This model highly encourages providers to focus on their patient outcomes rather than the number of services (pap smears, vaccinations, CT scans, etc.) that they provide in their practice each week.

Managed Care Plans—HMOs and More

Managed care plans come in different forms. These include HMO, PPO, Point of Service (POS), and Exclusive Provider Organization (EPO) plans. Each plan offers varying levels of flexibility and cost management. They are best tailored to meet the needs of different patient populations.

Not Just Focused on Payment

The role of managed care in value-based care does more than focus on payments. MCOs invest in technologies and data analytics to track patient outcomes and identify areas that need improvement in healthcare facilities. This proactive approach helps in managing the health of various populations. Consequently, patients receive the right care at the right time. This can be quite beneficial to struggling populations that have fewer doctors or facilities.

Meeting the Metrics

How does it work? The BPCI Advanced program rewards providers for meeting specific patient outcomes. This creates a financial incentive for providers to deliver high-quality care while keeping the expenses reasonable. Payers, including both public and private, collaborate with managed care organizations to create value-based care models. They ensure that providers have the resources and incentives necessary to then achieve better health outcomes for their patients.

Bringing the Payer, Provider, and Patients Together

Ultimately, managed care organizations are essential to transition from the past flawed systems to value-based care. They bring together payers, providers, and patients to create a healthcare system that prioritizes quality and efficiency. This not only improves patient outcomes but reduces healthcare costs at the same time.

For more information on managed care in value-based care models, consult our experts at Guideway Care. Let us work with you to implement proven systems like BPCI Advanced and enhance the overall patient experience.