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In the Middle: Transitioning from Fee-for-Service to Value-Based Care

Posted by Ron Manke - Thursday, November, 15 2018

I have two brothers – both younger.  Being the oldest has its advantages.   I am sure being the youngest also has its advantages.  But being in the middle, well, that’s just in the middle.  Sometimes being in the middle is not fun.  


Our American healthcare system is in the middle.  We are actively transitioning from an old Fee-for-Service (FFS) system of reimbursement to a new Value-Based Care (VBC) model of the future.    

Our poor physicians have grown accustom to working in Fee-for-Service.  This method of reimbursement has been part of our culture from both the patient’s side and from the physician side.  Doctors are used to delivering a service and receiving payment 30+ days later.   

In a Value-Based Care model, physician’s get some money up front for care coordination, reimbursement for the office visit, and additional bonuses at the end of the year for lowering cost and lowering utilization.   This model has many physicians supporting patients in wellness programs.   

Doctors are now focused on patient engagement and encouraging patients to stay connected with the practice for education and ongoing support.   Here are a few examples: 

  1. Text messaging patients on a weekly basis with encouraging information to help stay on care plans.  
  2. Emailing recipes for heart healthy meals with local coupons and organic ingredients.
  3. Setting up group visits with culturally similar patients to help them feel comfortable and ask questions.

Shared decision-making questions have helped patients better communicate with their doctor and stay engaged with their care teams.  Feedback from patients is collected and analyzed.  This all leads to better outcomes and higher patient satisfaction in the healthcare delivery system.    

In life, we all go through transitions.  We enter school as the youngest and graduate the oldest, only to do it over and over again.  The process is not always easy and comfortable, but we do grow.   

One final thought: My middle brother is the only one who can say, I have one older brother and one younger brother.  He has lived his entire life in the middle.  Our healthcare transition allows physicians to do both, Fee-for-Service and Value-Based Care.  Maybe being in the middle of FFS to VBC is not so bad after all.

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