The value-based care model: Identifying costs and rewards
The shift from the fee-for-service to value-based care delivery model is accelerating, with CMS aiming for 100% of Medicare beneficiaries in value-based arrangements by 2030. For skilled nursing and long-term care providers, this means financial incentives are increasingly tied to quality metrics, interoperability, and the total cost of care.
Change isn’t easy. And adopting an operational model that supports value-based care reimbursement models requires upfront investments in clinical team training, provider alignment, technology, tracking outcomes and cost, and workflow redesign. The question becomes, how do you balance this against the potential rewards? To answer that, we’ll explore:
Upfront costs against future rewards
Shifting from the traditional fee-for-service mindset isn’t easy. Providers had relatively predictable reimbursement that comes coming from each service provided without having to consider future impact. Value-based care flips this model, rewarding better care resulting in quality outcomes and a lower total cost of care, but the benefit is often after the fact. This delay can feel risky, especially when upfront investments are required.
Initial investments, such as education for clinical and non‑clinical teams, engaging providers, analytical systems, and process and network development, can put a strain on operations. Leaders must dedicate time to cultivating relationships with hospitals, physicians, and payors willing to collaborate on resident‑centered approaches. But organizations can effectively transition by committing to ongoing process improvement and ensuring teams are aligned with the changing model of care.
Financial incentives to offset investment
Know your population. Know what you do well and what programs are available to you and within your market. There are many ways to start benefiting from the quality care and outcomes you provide.
Becoming a preferred provider partner
Reach out to payors and hospital systems, share your data, and become a preferred network provider. Make your facility the facility of choice, increasing admissions and opportunities for improved care coordination and collaboration. Depending on your confidence level, you can also negotiate with your cross-continuum partners or payor partners to share in the savings or apply bonuses for success. Some of these relationships can involve downside risk but will have the potential for a more upside as well. You can start small, gather your metrics, and build confidence over time.
Shared savings programs
Join hospitals and other providers in Accountable Care Organizations (ACOs) to collaborate in delivering high-quality, highly coordinated care. By achieving already-established care quality and cost metric targets, the ACO providers share in a portion of the financial savings generated for the payor. ACOs that regularly offer high-quality care at a lower cost can experience the benefit of routine payments from shared savings.
Performance-based programs
Track your performance measures in key quality outcomes and preventive care measures. Use this data and work continuously to improve. You can earn rewards and get dollars back when your performance meets or exceeds rate benchmarks as well as by proving your commitment to quality care through significant improvements in your scores.
Aligning culture, data, and technology
Value-based care is more than just chasing rewards or incentives. It’s about creating a strong foundation for lasting success. Effective providers focus on creating a culture around quality and develop systems that improve resident care, where financial rewards follow naturally from highly effective healthcare delivery models.
Culture and staff incentives
Cultivating a culture that rewards quality over quantity is the foundation for success in value‑based care. That means shifting provider incentives from volume‑driven targets (number of complete tasks) to outcome‑driven goals (number of residents who met their functional benchmarks). Ensure your clinical teams understand quality of care is the goal, and it’s driving the shift in delivery model and processes.
Insightful data and reporting
Empower your teams to provide the best care to your residents by surfacing actionable insights at the right time. You can then monitor use, track progress, and course‑correct quickly. Avoid generating reports for reports’ sake. And choose dashboards that highlight only the most critical metrics, like hospitalizations, length of stay, ER visits, and resident‑reported outcomes.
Powerful tech integrations
Technology becomes the catalyst that ties culture and data together. Interoperability ensures your EHR, analytics, and workflow automation tools work together. This gives caregivers an efficient experience as well as a complete, real-time view of each resident to support better care and outcomes. Make sure to chose technology that produces only relevant information that naturally fits into your systems. You can avoid overwhelming your team, minimize manual tasks, and maximize your team’s impact on outcomes.
When culture, data, and technology align, transitioning to value-based care models turns into a strategic advantage. Providers gain insights into the residents they serve, their competitive advantages, and a culture that will support long-term success.
Charting your path with a phased approach
Embarking on value‑based care doesn’t happen overnight. A phased approach helps you balance risk and reward:
Phase 1: Assessment and goal setting
Conduct a gap analysis on quality metrics (hospitalizations, care coordination, resident satisfaction) and technology maturity. Set SMART goals, like reducing readmissions by 8% within 12 months, and identify where workflow automation and actionable insights can make the biggest impact.
Phase 2: Pilot and quick wins
Begin working with your cross-continuum partners, collaborating for improved care across the resident journey. Ensure you have the analytics to effectively tell your story as you become the preferred provider. Share your data not only externally, but also internally. Share results routinely. Celebrate big and small victories to support the culture of care, ensure progression, build confidence, and justify further investment in expanding your value-related relationships.
Phase 3: Scale and optimize
As you gain experience and sustain quality care delivery at a lower total cost, explore relationships with a greater upside. These can include downside risk, so your teams need to be ready for the challenge. Ensure incentives are tied to quality and align with operational success. Take advantage of the benefits of interoperability, automation, and proactive care. Monitor key metrics and leverage quality assurance processes so you can pivot quickly to stay ahead.
Making value-based care work for your organization
Value‑based care presents a dual challenge—meaningful incentives exist, but they require thoughtful investment. By starting small, managing risk, and focusing on people, culture, and technology, providers can turn upfront costs into long‑term gains. A culture that rewards outcomes, combined with smart reporting, workflow automation, and interoperability, sets the stage for shared savings and performance bonuses.
Discover what’s next with MatrixCare
Take stock of where you are today, define clear goals, and pilot low‑risk incentive programs to gain momentum. As you scale, invest in integrated solution providers and platforms, like MatrixCare, that can support data‑driven decision‑making and help position your organization for success in value‑based care.
MatrixCare can support your efforts by helping simplify quality reporting and performance tracking, provide actionable analytics, and strengthen collaboration across care teams with integrated workflows. Our advanced tools are designed to enhance resident outcomes in value-based care by helping reduce readmissions, improve resident satisfaction, and enhance care coordination.
Explore how MatrixCare can help you on your journey in value-based care.
Allison Rainey
As our Head of Nursing and Clinical Informatics, Allison Rainey oversees the deployment of clinical technologies. As a Registered Nurse and License Family Practitioner, Allison drives a caregiver-first approach in our products, collaborating closely with product leaders to ensures our products and services prioritize the needs and challenges faced by healthcare providers. By aligning workflows, designs, and overall product strategy, Allison strives to offer the most user-friendly, clinically superior, and efficient suite of comprehensive solutions in the industry. Allison brings extensive post-acute care experience from her 20-year tenure at NHC, one the largest publicly traded Senior Care providers in the U.S. She is a seasoned leader in population health management strategy, clinical reporting and analytics development, and inpatient hospital care. In her most recent role as AVP of Clinical Information Technology, she oversaw the deployment and utilization of various clinical technologies, including the MatrixCare EHR, across the extensive NHC network. Allison holds a Bachelor’s and a Master’s in Nursing from the University of Tennessee.
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