Last week we explained how Value Based Reimbursement (VBR) helps incentivize the best care over the most care. Don’t read it if you’re hungry, because we used Bojangles’ sauces to help make the point.
There’s another side to VBR, though – one that health care providers can get behind:
VBR lets doctors be doctors.
You’ve probably heard stories about insurance companies denying coverage for treatments recommended by physicians. This often happens when insurers are reimbursing health care providers on a fee-for-service basis. Because, in this model, providers are reimbursed for everything they do, there has to be a check to make sure services that are likely to be ineffective, unnecessary, or duplicative are avoided.
This is a process is called prior authorization and it can be frustrating to patients who find themselves in the middle of a fight between their doctors and their insurer. Unfortunately, if not for this check, costs would be (even more) out of control and premiums would skyrocket (even higher). Patients could even be subjected to potentially dangerous procedures.
Prior authorization can also be frustrating for doctors who just want to do the best they can for their patients.
This is why VBR is such a great innovation. Because providers are reimbursed for the value they provide rather than the quantity of stuff they do, they have more freedom to treat their patients as they see best.
In this model, the insurer shares the financial risk with the provider. That means that providers have an incentive to be their own check to ensure costs remain within reason and to use treatments that have proven to be the best chance at a cure.
Basically, providers stand to lose money if they perform services that are ineffective, unnecessary or duplicative.
Value Based Reimbursement means insurance companies can spend less time reviewing treatment plans and doctors can be doctors.
Believe it or not, Value Based Reimbursement is currently not allowed in North Carolina, but it may be soon. Sign up for updates on this important issue and help us lead the charge!