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Value-Based Care: What Every Social Worker Should Know

Embracing a preventive model, medical social workers facilitate patient care as valued members of healthcare teams.

Though Americans pay the highest costs for healthcare in the world, they aren’t getting what they pay for. Compared to other industrialized countries, our healthcare system delivers relatively unexceptional health outcomes. There is plenty of room for improvement. Many in public health and healthcare careers believe adjusting our healthcare service model could solve a lot of problems. Traditionally, American hospitals and healthcare providers have used a “fee-for-service” model, but many believe our country should instead adopt a “value-based” system.

While these two models may sound complicated, they’re not. A fee-for-service model is like it sounds: Patients pay fees for services rendered by their healthcare providers. In a 2019 interview with Social Work Today, Abigail M. Ross, MSW, MPH, PhD, said fee-for-service “rewards individual providers for both the volume and quantity of services provided—which is often characterized in healthcare settings as ‘productivity.’ ” In her words, “it reimburses healthcare providers based on the number of patients seen, services provided, tests completed, or procedures conducted.”1

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In contrast, in a value-based care model, patients pay hospitals and healthcare providers based on health outcomes. This model rewards providers for improving patient health and reducing disease. The value-based model encourages preventive medicine, reducing the time and resources that need to be allocated to chronic disease management.2

According to 2016 data from the American Medical Association, 70.8% of medical practice revenue is earned through fee-for-service models.3 Around the same time, 2017 data from the Business Group on Health found that close to 40% of employers “have incorporated some type of value-based benefit design in which employees receive reduced cost sharing or premium reductions when they take steps to manage chronic conditions or obtain higher-quality or more efficient care.”4

Clare Pierce-Wrobel, MHSA, senior director for the Health Care Transformation Task Force, explains that in value-based care, risk is transferred from payer to provider. This makes providers “responsible for the risk of inappropriate or ineffective care,” she noted. This approach financially incentivizes providers. “If there are savings to be had in their [value-based] approach, the providers will be able to share in those cost incentives,” Pierce-Wrobel says.1

What do social workers do in a value-based care model? How does value-based care impact social worker jobs?

Social workers work with patients and their families to facilitate their medical care. Their duties include case management, counseling, arranging services following hospital stays, coordinating with insurance, referrals, and discharge planning. While medical social workers typically assist those with physical health issues, like chronic conditions or terminal diseases, clinical social workers help patients with mental health needs. Both types of social workers might find employment in hospitals, nursing homes, hospice, public health clinics, substance abuse treatment facilities, or centers for rehabilitative care.5,6

Social workers are not only instrumental to patients and their families, but also to interdisciplinary healthcare teams, including doctors, nurses, therapists, specialists, and adminstrators.6 As healthcare steers toward more holistic, preventive approaches like value-based care, those in social work practice will take on greater roles.

The social worker makes assessments of a patient’s well-being, and in particular studies his or her social, emotional, financial, and support needs. The social worker then updates the patient’s doctors, nurses, and healthcare team to ensure the patient’s needs are met during care. This work doesn’t end at the briefing stage, however. The social worker also takes a primary role in handling patient discharge, including securing medical equipment, and coordinating follow-up care, transportation, insurance and billing, and access to public health resources.7

As care diverts from the fee-for-service model and toward preventative value-based care, the assessments, planning, and involvement of those in social work careers will become increasingly important. Overhauling the current healthcare system will be a laborious challenge, but not insurmountable. Implementing value-based care will take the dedication of administrators, healthcare providers, insurers, and social workers alike. As facilitators to all of these groups, social workers are critical to today’s and tomorrow’s healthcare system.

Are you interested in how to become to become a social worker? Most of today’s social worker jobs require a master of social work, or MSW degree.7 Walden’s online MSW program prepares students for a wide variety of social work careers, including medical, clinical, and military. With four available concentrations, Walden’s online social work degree program can meet your career needs.

Walden University is an accredited institution with online education options that include a Master of Social Work (MSW) program. Expand your career options and earn your degree using a convenient, flexible learning platform that fits your busy life.

1Source: www.socialworktoday.com/archive/MJ19p24.shtml
2Source: https://catalyst.nejm.org/what-is-value-based-healthcare/
3Source: www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/health-policy/prp-medical-home-aco-payment.pdf
4Source: www.globenewswire.com/news-release/2017/08/08/1081671/0/en/Large-U-S-Employers-Project-Health-Care-Benefit-Costs-to-Surpass-14-000-per-Employee-in-2018-National-Business-Group-on-Health-Survey-Finds.html
5Source: https://learn.org/directory/category/Health_Professions_and_Medical_Services/Mental_Health_Professions/Clinical_and_Medical_Social_Work.html
6Source: www.mswguide.org/careers/medical-social-work/
7Source: www.ecfmg.org/echo/team-psych-msw.html

Walden University is accredited by The Higher Learning Commission, www.hlcommission.org.

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