The State of Value-Based Purchasing
In recent years, value-based care (VBC) and value-based payments (VBP) have gained more traction in the healthcare industry, but the system is far from perfect. The fee-for-service (FFS) chassis is one of the main reasons the payment model has been unable to achieve its true and best form.
Brian Wheeler, Vice President of Provider Collaboration and Network Transformation for CareFirst BlueCross BlueShield, spoke with Health Leaders Media on the FFS chassis and the billing process. This platform is still how many services are billed, and VBC is struggling to remove itself from this model.
“Healthcare delivery system partners and payers are still very dependent on the flow of fee-for-service claims. Many benefit designs cannot be administered without a known unit cost for the service provided. Electronic health records [EHRs] , the billing systems, the accounting systems—the whole system is built around this."
Brian Wheeler, Vice President of Provider Collaboration and Network Transformation for CareFirst BlueCross BlueShield
Wheeler noted that CareFirst has a unique approach to relationship management between providers and payers. Teams work to identify data and patterns to adjust claims data to a measurable, rewardable factor.