“The strong sense that I have is that there is a bit of a disconnect, where it feels on the ground like people believe that value-based payment models may be good for finance and health care expenditures but they are not going to be good for patients and providers,” Dr. Nijagal said in an interview. “I totally disagree.”
Rather, value-based payment models are a way to increase provider autonomy.
“Specific to maternity care and across health care, at this point, insurers are the ones who decide what services we can provide,” she said. “They have their fee schedules and that limits what we can do. What value-based payments and episode payments allow us to do is that, as providers, if we end up saving money from avoiding unnecessary interventions and diagnostics, we then get some of that money back to provide services that may not be covered.”
Dr. Nijagal and her colleagues looked at maternity care bundles and episode payment models in state Medicaid programs, managed care plans, and self-insured employers and found that physicians and other providers can benefit from participation in four ways, by: