The transition from a Fee-For-Service (FFS) model to a Value-Based Care (VBC) model in the healthcare space has been revolutionary. As providers put more of an emphasis on delivering high-quality care while attempting to lower costs, this causes a strong impact on revenue cycle management (RCM).

Fee-for-service is the traditional payment model where providers are reimbursed for each service they deliver to a patient, whilst value-based care is a new approach that incentivizes providers to focus on quality outcomes rather than the volume of services provided. FFS incentivizes providers to provide as many services as possible while VBC focuses on quality of care and outcomes. The National Academy of Medicine defines value-based care (VBC) as safe, timely, efficient, equitable, effective, and patient-centered — or STEEEP.

So, how does the change from FFS to VBC affect RCM? The FFS business model comes with a very straightforward medical billing and coding process, whilst VBC requires more advanced reporting metrics. VBC requires key performance indicators (KPIs) like patient outcomes, satisfaction levels, clinical quality, and patient leakage to be tracked, complicating the simpler RCM system used with an FFS business model. 

With value-based care also comes a change in reimbursement models, such as pay-for-performance and bundled payments. To accommodate these new models, healthcare organizations must alter their RCM procedures, specifically their medical coding, to make sure their system can accept each payment type.

Another way in which VBC affects RCM is through patient teachings and interactions. It is important for administrators to educate patients on costs, how to read billing statements, and all about how to handle the financial aspects of receiving medical care. 

Technology plays a huge role in maximizing the VBC and RCM duo. Electronic health records, RCM software, and advanced analytics platforms enable healthcare organizations to capture, analyze, and leverage data to drive performance improvements, further improving patient satisfaction levels. 

Value-based care in healthcare is a tremendous development and positively affects millions of people worldwide. It is important for providers to know how the transition to value-based care may affect their current RCM procedures.