Value-based care for employers is a kind of health plan for a company that insures its own staff, in which doctors are paid for keeping people healthy rather than for each treatment they give. It is sold in the United States. There, most working people get health insurance through their employer. Some companies that build these plans have engineers in Bengaluru.
Two ideas need explaining first. The first is self-insurance. Many large American employers do not buy a policy from an insurer. Instead, they pay their staff's medical bills from the company's own money. They hire a third-party administrator, a company that processes the claims for them. The employer carries the cost, so the employer gains directly if costs fall.
The second is value-based payment. In the usual system, called fee-for-service, a doctor is paid for every visit, test and operation. So the doctor earns more when patients need more treatment. In a value-based plan, a group of primary care doctors is paid a fixed amount per member per month. They also share in the savings if the employer's total medical costs come in below a target. So the doctors earn more when patients stay healthy.
Consider a manufacturer in Indianapolis, Indiana, in the United States, with 3,000 staff. Last year it spent $42 million on its staff's medical bills. Under a value-based plan, it pays a primary care group $90 per member per month. That money covers unlimited visits to the group's doctors. The plan sets a target of $40 million for total costs this year. The doctors call staff with high blood pressure every month. They refer staff with back pain to digital physiotherapy before any scan or surgery. If total costs end at $38 million, the doctors receive an agreed part of the $2 million saved.
The plan's software holds the members, the doctors' contracts and the savings calculation. Staff sign up for the plan through the employer's benefits administration software. Claims are decided by claims adjudication. Members with serious illnesses are followed through care management software.
In India, employers usually buy group health insurance for their staff from an insurer, with a fixed premium for each employee. The insurer, not the employer, carries the cost of the claims. So an Indian employer has less direct reason to change how doctors are paid.