Value-Based Care Models
| Model | Description | Employer Access |
|---|---|---|
| ACO (Accountable Care Organization) | Provider network accountable for total cost and quality | Through carrier contracts |
| Bundled payments | Single payment for episode of care | Through carrier or direct contract |
| Direct primary care | Monthly fee for unlimited primary care access | Direct employer contract |
| Patient-centered medical home | Enhanced primary care with care coordination | Through carrier contracts |
| Oncology care model | Value-based oncology care with quality metrics | Through carrier or COE contracts |
Employer Value-Based Care Strategy
Employers can access value-based care through: (1) carrier contracts that include ACO or value-based care options; (2) direct contracts with value-based care providers; and (3) coalition contracts that aggregate employer purchasing power for value-based care. The most effective employer value-based care strategy combines DPC for primary care with value-based specialty contracts for high-cost conditions.
The Value-Based Future
IQ Insight
The shift to value-based care is accelerating. CMS has committed to having all Medicare beneficiaries in value-based care arrangements by 2030. Commercial payers are following. Employers who position their plans for value-based care — through DPC, direct contracts, and coalition purchasing — will be ahead of the curve and will benefit from better outcomes and lower costs.