One new study suggests better outcomes with value-based care versus fee-for-service Medicare

The evidence will compel more physicians to embrace data-driven healthcare

A study directly comparing results from a Medicare Advantage (MA) two-sided risk model to fee-for-service (FFS) Medicare is making a positive impact in the transformation to value-based care.

According to Kenneth Cohen, MD, FACP, executive director of translational research for Optum Health and co-author of the study published in JAMA Network Open, the research speaks to the value of coordinated care, evidence-based practices and the alignment of financial incentives with patient outcomes.

“The implications of the study are far-reaching as they validate value-based care as the path forward to more affordable care that delivers better results,” said Dr. Cohen. “We’ve seen some studies that demonstrate better outcomes in value-based models, but this is the first comparison with FFS, which is critical because it shows how clear the rationale is for moving to a model rooted in delivering high-value appropriate care. This level of data analysis is extremely important in driving the adoption of value-based programs.”

Data-driven care decisions affect outcomes

With data and analytics to drive value-based decisions, physicians could also choose more effective drugs at lower costs, ultimately benefitting patients clinically and economically. Dr. Cohen explained one drug they evaluated was an expensive migraine medication. Physicians were able to compare costs and research for all medications that reduce the frequency of chronic migraines and find effective, lower-cost options for patients.

They also had access to quality performance data that gave them visibility into which specialists were delivering high-value care. With this information at their fingertips, they could be more targeted with their referrals and continue to direct patients to quality care.

In addition, the data helped to stratify the population and identify at-risk patients, so physicians could implement disease interventions and lower the risk of hospitalizations.

“The MA model of care provides revenue to risk stratify patients and deploy sophisticated care management strategies for the highest risk patients that otherwise wouldn’t be possible in FFS,” continued Dr. Cohen. “These strategies also drive a critical shift from patients paying for low-value care to instead paying the same price for high-value care and getting better results.”