Recent data shows Value-Based Care improves health outcomes in Georgia

As part of its efforts to continually improve residents’ health and access to care, the state of Georgia proudly stands as an early adopter of a nationwide shift toward Value-Based Care, which incentivizes providers to value quality of care over number of patients treated. This health care delivery model reimburses providers – such as physicians, hospitals, labs, nurses and others --based on the health outcomes of their patients and the quality of service rendered. 

At CareSource, we can substantiate that an increase in provider participation in Value-Based Care has directly led to improved quality of health care for our members. In fact, providers participating in CareSource Value-Based Care models have notably elevated the quality of and access to health care across the entire state. Recently, CareSource released new data showing the impact of our Value-Based Care (VBC) programs, which align payer, provider and member actions to achieve and reward higher quality health outcomes.

Without a doubt, our CareSource VBC model helps to keep our members healthier and our providers happier while also lowering costs. Preventative care visits are on the rise while emergent and curative care rates decline.

This latest data reveals a remarkable year-over-year improvement in health outcomes for Value-Based Care members throughout the state, resulting in reduced or eliminated out-of-pocket expenses and mitigates Medicaid program expenditures for the state. Today, more than 80% of CareSource members now receive their care from providers with Value-Based Care provider agreements.

CareSource has achieved notable success in six key focus measures established by the Georgia Department of Community Health, with significant health gains in 2022 compared to 2021:

• Breast cancer screenings (+3.4%)
• Controlling blood pressure (+ 8.6%)
• Childhood immunizations (+6.7%)
• Prenatal care (+3.3%)
• Postpartum care (+8.8%)
• Blood glucose level control (+11.5%)

These measurements hold great significance as an increased number of wellness checks, completed vaccination schedules, and comprehensive monitoring in a child’s first year of life can prevent many illnesses and help diagnose more serious diseases at earlier stages. In fact, CareSource members enrolled in Value-Based Care programs experienced 16% fewer emergency room visits, 38% fewer hospital admissions and a 5% lower hospital readmission rate.

CareSource offers nine unique VBC programs to our providers in order to best serve the specific needs of our members.  Last year, CareSource awarded more than $8.5 million in incentives to health care providers achieving high-performing quality outcomes. Consequently, the number of members seeing primary care physicians annually doubled, the amount of VBC incentive payments to health care providers nearly doubled, and well child visits increased nearly 44% while preventative dental visits increased 10%.

Better health outcomes also mean more economic benefits to the state. Overall costs for members participating in a VBC program were 28% lower per member/per month than those who did not participate in a VBC program.

CareSource Value-Based Care programs represent a reimbursement model that rewards health care providers for the delivery of high-quality care and promoting the health and well-being of CareSource members.  Through these programs, CareSource remains committed to driving better health outcomes, enhancing member satisfaction and reducing costs for both members and the state as a whole.