Value-Based Care at VMC: Getting the Right Care to Every Patient

What is Value-Based Care? Put simply, Value-Based Care (VBC) is delivering the right care, at the right time, and in the right setting. It is health care that results in improved patient outcomes when delivered efficiently and cost-effectively.

Payers, including Medicare, Medicaid, and many commercial insurance companies, incentivize providers to deliver VBC by offering value-based arrangements (VBAs). VMC has many value-based payment arrangements with payers that result in increased revenue for VMC in the form of shared savings or quality incentives when specific quality metrics are met or when “total cost of care” targets are met.

To assess the quality of care we provide, capturing the disease burden of the patient population we serve is a critical first step. Without an accurate “picture” of our population’s disease burden, important quality metrics such as our mortality rate may not be reflected accurately.

“Risk adjustment” is the tool used to capture the disease burden of a patient population. Documenting certain chronic and acute medical conditions (known as “HCCs”) with accuracy and specificity is the mechanism that payors use to “risk adjust” our patient population.

In addition to documenting any new “HCCs” that our patients have now developed, previously documented “HCCs” (i.e., documented during the previous calendar year) must be revalidated (i.e., documented if still valid) every calendar year.

As we near the end of calendar year 2025, we must make every effort to close any “HCC coding gaps” – that is, we must make sure we revalidate any HCC diagnoses that have not yet been documented and addressed in the current calendar year.

Providing value-based care is the right thing to do because it results in better outcomes for our patients.

Many thanks to all of you for doing your part to ensure Valley Medical Center succeeds in providing excellent value-based care.