How Does Value-Based Healthcare Work?

 The functioning of a value based payment in healthcare is best illustrated with a real-world example. Let’s imagine there is a person named Robert. He is in his late fifties and has a desk job, and his job provides him with a private health insurance claims plan. One day, Robert visits his primary care physician with complaints of tingling, numbness, and a persistent burning sensation that began in his toes and is now working its way upward. The physician is part of an accountable Care Organization (ACO), a network of doctors and hospital management sharing financial and clinical responsibilities for providing coordinated care.   

Robert has been overweight for about a decade, smokes and drinks every week. In light of this family history, his primary care physician may suffer from nerve damage—the physician coordinates with a laboratory that conducts blood tests. When the results are out, it is revealed that Robert has serious Type 2 diabetes, which causes diabetic neuropathy (nerve damage). It is common for people who have unmanaged diabetes for many years.  

Excessive sugar damages the walls of the capillaries that supply precious blood to the nerves. This holds especially true for the patient’s legs. If left unchecked, the nervous damage (neuropathy) will worsen and eventually lose sensation in the legs. The loss of sensation, tingling, or burning starts from the toes and advances upward.   

Since Robert’s care team is a part of an ACO, he gets connected to a nurse care manager who educates him about his condition. Robert is told about the cause and impact of his disease and how to manage it better through a healthy diet, exercise, and giving up smoking and alcohol. He is also told which types of food to avoid and counselled about managing his stress better.