Value-based care, explained

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athenahealth
January 31, 2025
3 min read

Our healthcare system is in a state of flux, and perhaps the most promising evolution underway is a shift to more quality and cost-effective care, incentivized by programs under the umbrella of value-based care (VBC). This emerging approach to healthcare—which is also often referred to as quality programs or alternate payment models—is intended to address and recalibrate many of the pitfalls of the US healthcare system which have simultaneously caused rising costs and falling health outcomes.

Whether you’re new to the topic or help run a practice that already participates in quality programs, the next five years will be crucial for establishing the capabilities and support you need to thrive under VBC. If you care for patients on Medicare, you likely already know that the Centers for Medicare & Medicaid Services (CMS) has set a deadline of 2030 to have 100% of Medicare enrollees in VBC programs.1 This shift also has implications for the broader business of healthcare: analysis by Bain & Co. suggests fee-for-value arrangements will capture 15%–20% market share from traditional fee-for-service providers in primary care by 2030.2

It may feel daunting to dip your toe into the complex and unfamiliar world of VBC but be encouraged: athenahealth research shows that physicians using a mix of fee-for-service and one or more value-based care models feel more financially secure.3

To help you evaluate your readiness for VBC and help you prepare to succeed with quality-based models, we’ve developed this series of educational articles written for physicians, clinicians, and healthcare administrators like you.

Peruse the articles below; and don’t forget to bookmark this page and check back often. We’ll add new articles and information as we publish it.

Are you ready for a value-based care model?

Need the basics about value-based care? This article covers the what, who, and how—basic definitions, key components of VBC, important skills for success—of this important approach to care. 

Exploring different value-based care models

This article provides introductory-level overviews of four types of value-based care payment models—pay for performance (or fee-for-value), quality incentives, shared savings and risk, and global capitation. 

Understanding value based healthcare reimbursement models

Take a deeper dive into the four value-based care payment models, review each in the context of popular quality programs, and learn when and how you’ll be paid under different reimbursement arrangements. 

How to choose the right value-based care model for your practice

Which type of quality programs are best for your practice? This article guides you through that question by helping you consider your current capabilities, patient demographics, and more.

No matter where you are in your value-based care journey, athenaOne can help you take your next step toward prioritizing quality and achieving the great incentives available to you.

For example, do you understand the ins-and-outs of the CMS’ Quality Payment Program (QPP) and Merit-based Incentive Payment System? We do, and our technology, insights, and expertise can help you achieve positive payments adjustments to your Medicare Part B.

athenaOne is built to be highly interoperable and is a Certified Electronic Health Records Technology (CEHRT) solution. And athenaOne’s software and services make medical billing and revenue cycle management—for both value-based contracts and traditional fee-for-service billing—more efficient and accurate than ever before.

Value-Based ContractsPay For PerformanceGlobal CapitationShared Savings VBC

1. CMS, June 2023, The CMS Innovation Center’s Strategy to Support High-quality Primary Care; https://www.cms.gov/blog/cms-innovation-centers-strategy-support-high-quality-primary-care

2. Bain & Company, Apr. 2023, "Global Healthcare Private Equity and M&A Report 2023"; https://www.bain.com/globalassets/noindex/2023/bain_report_global_healthcare_private_equity_and_ma_2023.pdf; IS009

3. 2023 Physician Sentiment Survey, commissioned by athenahealth and fielded by Harris Poll, Jan 2024

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