Alternative Payment Models Help Medicare Patients Better Manage Chronic Conditions

Value-based care models pay hospitals and providers, in part, on quality and care outcomes. These models help organizations like Coastal Carolina Quality Care in North Carolina provide one-on-one support for patients living with chronic conditions so they can stay out of the hospital.

Peter's story:

For years, Peter struggled to manage his coronary artery disease and congestive heart failure. To help him better manage these conditions his physician assigned him a care manager to check in on him between visits. During one of these regular virtual check-ins, the manager noticed a symptom that Peter had not yet recognized. 

The care manager conferred with Peter’s physician and arranged for him to be evaluated later that day at the group’s extended care clinic. They diagnosed the problem and immediately began treatments that took several days to complete. 

Once Peter’s condition stabilized his care manager learned he had not been taking his medications regularly because he was unable to afford them. Once this impediment was recognized his manager helped him apply for a prescription savings card that alleviated this problem. 

The incentives created by value-based-care led Coastal Carolina Quality Care to hire care managers and to establish their extended care clinic. Thanks to these programs Peter feels in control of his health and avoided an unnecessary hospitalization. Without this level of personalized, coordinated care, Peter does not think he would be here today.

Because value-based care focuses on outcomes, health organizations like Coastal Caroline Quality Care can help patients manage their chronic conditions to prevent problems that could lead to hospitalization. Without continued support for value-based care models, patients like Peter may not get the support they need.

This patient story has been de-identified to protect patient privacy consistent with HIPAA – no real patient names are referenced, while the experience described reflects actual events.