An Overview of Value-Based Care for Primary Care Practices

Over the past decade, the healthcare industry has gone through significant change. New concepts, workflows, and requirements can be confusing and frustrating for physicians who are already stretched to their limit caring for patients, which is why the world of value-based care can present physicians with exciting opportunities to improve patient outcomes while thriving financially.

With value-based care, physicians are reimbursed based on quality rather than volume. The goal is to support patients at their highest possible level of wellness rather than wait to provide care until they get sick, which is often more complex and expensive.

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In value-based care arrangements, physicians contract with payers, such as Medicare, Medicaid, and commercial insurance companies, to care for a defined set of patients. Physicians can earn financial rewards by meeting specific performance and quality measures tied to better long-term outcomes for patients. These measures may include the delivery of routine and preventive care services and chronic disease management services.

Accountable care organizations, or ACOs, help physicians formalize their approach to value-based care. ACOs are groups of practices that contract with a payer to achieve the shared goals of improving outcomes and reducing unnecessary spending.

ACOs can contract with many different types of payers, including Medicare, Medicare Advantage, Medicaid, and commercial insurance entities. Financial risk and the opportunity to earn incentives for positive results are what makes these arrangements so innovative. If an ACO successfully meets its quality and spending targets, the practices in that ACO could receive a portion of the resulting shared savings, or the difference between what the payer expects to spend and what the payer actually spends on care for those attributed patients.

By prioritizing quality-driven accountable care, participating practices aim to make healthcare better for patients in need. For independent primary care practices, value-based care may bring more benefits. The potential to earn shared savings and other revenue enhancements can provide financial relief while allowing clinicians to strengthen the rewarding patient relationships that are the backbone of primary care.

CAP understands the financial hardships many of California’s independent physicians are experiencing and continues to seek opportunities that can help our members’ practices increase revenue and improve outcomes. CAP is pleased to welcome Aledade, Inc., a company committed to helping medical practices thrive in value-based programs, as the newest participant in the CAPAdvantage program, CAP’s member-exclusive suite of no-cost or discounted practice management products and services specifically selected to support your success.

Aledade partners with independent practices, health centers, and clinics to build and lead ACOs anchored in primary care. Nationwide, Aledade’s ACOs are empowering clinicians to stay independent, practice medicine like they’ve always wanted to, and thrive financially while keeping their patients and communities healthy. Together, these physician-led ACOs are reducing healthcare costs, improving outcomes for patients, uncovering new revenue opportunities, and diversifying revenue streams beyond fee-for-service through value-based care.

Aledade recognizes that primary care doctors cannot make the shift to value-based care alone. They need and want a partner who understands their unique needs, and who can provide regulatory expertise, cutting edge technology, data analytics, business transformation services, and all the other elements they need to succeed in value-based healthcare.

CAP members who join an Aledade ACO before July 31, 2021, will receive special enrollment benefits, including a waived implementation fee as well as access to Aledade’s expansive library of resources and support services for primary care practices. To learn more about this opportunity, visit https://info.aledade.com/CAP_partnership.