Value-based care: Better health, lower costs

The U.S. health care system faces many challenges around increasing cost and a shrinking workforce. Doctors want more time with their patients — most say they wish they could spend more time with patients with complex conditions. Rising costs can be another barrier to care. One survey found that, in 2023, more than half of employees delayed medical care due to cost.* Employers who offer health plans to their employees also feel the pressure, as health care costs continue to rise.

Value-based care (VBC) offers a better way. The value-based care model pays doctors based on the results of how they treat their patients — not how many tests or visits they do. If patients are healthier and happier based on the treatment from their doctor, doctors can earn more. Across the country, more doctors and health plans are switching to this approach. At Aetna®, a majority of Medicare Advantage plans use VBC partnerships.

VBC helps fix many of the problems in health care. Patients get care built around their needs from a team that knows them, which helps them stay healthier and spend less. Doctors can focus on quality care instead of rushing through appointments. Employers can offer better health benefits and still manage costs.

Aetna has been pursuing VBC arrangements for many years. Today, we’re building on that work by growing our network, giving providers new tools and data and creating stronger partnerships. Our strategy focuses on high-quality care and collaboration.

Value-based care vs. fee-for-service

In the traditional health care system, doctors are paid for each test, service or visit. This is called fee-for-service (FFS). VBC is different. It helps doctors keep patients healthy by focusing on prevention, coordinated care and improved outcomes.

At Aetna, our VBC models help doctors deliver better care than they do under fee-for-service payment models. When providers focus on quality, it helps lower costs. We also share savings with doctors so they can invest in services that improve care.

Benefits of value-based care

Value-based care arrangements help members get:

• Better coordinated care, like support for mental health, physical therapy and medications
• More time with their doctors
• Faster appointment access
• Easier access to care, including online scheduling, messaging and virtual visits
• Help beyond medical care, like rides to appointments or support with healthy food

VBC helps providers to look at total health needs. It addresses not just medical needs, but also the everyday things that affect health, like food, housing and transportation (social determinants of health). For example, if a patient is overdue for a test, a doctor may help schedule it and, in some cases, arrange a ride. This kind of coordination leads to better health and fewer missed care needs.

Aetna is working to expand VBC partnerships so more members can see providers who use this approach to deliver better care at lower costs and help providers be successful in our VBC contracts.

Partnering with health care providers

Strong partnerships with doctors are key to making VBC work. We support providers at every step to help them succeed. Our approach includes:

• Working together on member care: Our teams partner with providers to develop strategies, track results and improve both the care experience and member health.
• Sharing data: We give doctors information on hospital admissions, claims, care needs and social factors that affect health, so they can make the best decisions for their patients.
• Improving care with innovation: We help doctors with new tools and ideas to make care better, easier to access and more connected.

The impact of value-based care

VBC is already making a difference. Aetna members who see doctors working in VBC are staying healthier compared to those who see doctors working in fee-for-service.

Focus on value results for higher-quality care (PDF)

VBC helps members stay healthier, spend less and stay out of the hospital. When health plans and doctors work together, patients get better care at a lower cost. As Aetna grows value-based care, we can create even more benefits for members, doctors and employers.