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Value-based care explained

What it is and why it's needed

This article was updated on April 17, 2023.

As a business person, you understand the importance of effective and efficient work. There’s nothing more frustrating than spinning your wheels — and spending your money — on efforts that fail to produce positive outcomes. Wellmark understands this, as well. That's why since 2012, we've been working to shift the outcomes of health care through value-based care. We believe value-based care can transform the way health care is delivered — from a system that treats disease to one that promotes prevention and improves overall health and well-being. 

What is value-based care?

Value-based care focuses on high-quality outcomes and lower costs through improved provider/patient relationships and coordinated care supported by data. In addition to coordinated care and data sharing, value-based care is changing the way providers are being reimbursed. Health care providers are reimbursed base on patient outcomes instead of the volume of services rendered. In a value-based care model, provider payments are tied directly to their ability to help their patients get healthy and stay healthy. 

How does it work?

There are two key elements that make a value-based care model work differently than we've seen in the past: 

  1. Coordinated care and data-sharing
  2. Value-based payment models

Coordinated care and data-sharing

When your employees visit value-based care providers, they become “attributed,” which means their primary care provider is responsible for monitoring their care. Wellmark provides data and analytics about each attributed member so the provider has a full 360-degree view of the member’s health. This information allows them to direct care based on:

  • Prevention and wellness needs
  • What other doctors or specialists a patient has visited
  • What drugs a patient has been prescribed
  • What treatments the patient has received

This enhanced coordination between Wellmark and providers leads to better managed chronic conditions, reduced emergency room and hospitalizations and lowered health care costs.

Value-based payment models

When Wellmark enters a value-based contract with provider, we’re sharing the risk with the provider. This means providers manage a defined population of patients (attributed members) and agree to payment that’s based on the health outcomes of those members and better containment of total cost. In other words, they’re reimbursed for value (results of care provided) rather than volume (quantity of services provided).

The providers in these Value-Based Payment Organizations (also called Accountable Care Organizations) are being held to specific quality and financial performance targets focused on preventative care and appropriate utilization in support of the management of chronic conditions.


How valuable is value-based care?

The value-based benefit design puts a stronger focus on overall health care versus sick care. Download a value-based care infographic that explains what your employees may experience with value-based care and results you may expect in the future. Log in to the Wellmark Marketing Toolkit to access. Just search for M-2022414.

The results of value-based care

Value-based care is seeing measurable results driven largely through better coordination of care. Success spans measurement categories such as appropriateness, chronic disease management, preventive care, and utilization.

In 2022, Wellmark value-based care providers continued to produce positive results in quality and cost outcomes including decreased hospital admissions and emergency room visits. Additionally, attributed members are receiving recommended preventive care at higher rates.

Educating and driving your employees to a value-based care provider allows you to be a part of the solution in the broken health care system and not just a passive bystander of rising costs.

The coordinated care, lower hospital admissions and readmissions, and increased preventive care results from value-based care leads to lower claims costs and increased employee time at work. A healthier employee population with fewer claims translates into a lower total cost of care.

Questions? Reach out to your Wellmark representative, or email us at Send Email.