Value-Based Healthcare and the Role of Nurse Practitioners

In conclusion, for value-based healthcare to benefit from the nursing model, NPs must be proactive in making their voices heard and not be shy to blow their horns in this changing landscape. Specialties NP Article


Value-based healthcare is changing the way healthcare providers and organizations provide care.

What is Value-based Healthcare?

Value-based healthcare is a health delivery model in which payment to healthcare providers and health systems is based on patients' health outcomes. This model focuses on improving efficiency by doing more high-value activities, thereby improving outcomes. Payers reward providers for helping patients reduce the incidence and complications of chronic disease, improve their health, and live healthier lives. It also emphasizes team-oriented patient care and data sharing so that care is coordinated and outcomes can be measured easily.

Value-based healthcare model adopts a fee-for-value approach rather than the traditional fee-for-service model, in which payment is based on the quantity of healthcare services providers deliver. In the value-based approach, health outcomes are measured against the cost of delivering the outcomes.

The Benefits of Value-based Healthcare Model

Everyone benefits from the value-based healthcare model.

Patients live healthier lives and achieve increased satisfaction.

Value-based healthcare encourages healthy habits and focuses on the prevention of chronic diseases and/or complications arising from those diseases. Focusing on prevention reduces poor habits such as overeating, sedentary lifestyle, smoking, and excessive alcohol consumption. This leads to spending less money on medications and fewer medical visits, tests, and procedures.

Providers achieve increased collaboration and greater efficiency.

Quality and patient engagement improve when the focus is on value instead of volume. This reduces burnout and errors. In addition, providers are better able to keep patients informed as value-based care centers around shared data through electronic medical records (EMRs). Moreover, with providers spending more time on prevention-based care, they will spend less time on chronic disease management, which can be time-consuming and sometimes frustrating.

Society becomes healthier, and at a lower cost.

Value-based care significantly reduces overall healthcare costs by reducing complications from chronic diseases, medical emergencies, and hospitalizations. National healthcare expenditure currently accounts for 18.3 percent of the Gross Domestic Product (GDP)1. This model promises to reduce this trend.

Overall, between 2021 and 2025, value-based contracts are projected to grow to 22 percent of insured lives from around 15 percent, covering nearly 65 million people in the United States, according to the March 2022 report from the management consulting firm McKinsey & Company2.

The Nurse Practitioner's Role

Nurse Practitioners (NPs) need to rethink their role in this changing landscape. While their physician counterparts are calling for medical schools to incorporate value-based healthcare principles in their curriculum, the nursing model's emphasis on high-value care, such as disease prevention and health maintenance, ideally positions NPs to contribute to the evolution of value-based care.

However, a recent study that was carried out to better understand NP-owned practice participation in value-based healthcare found that over 70 percent of NP practice owners report a lack of knowledge, financial protections, and payer partnership as barriers to participation in value-based payment models.

Given that the nursing model already emphasizes high-value care, as stated, the lack of knowledge is a surprising finding that needs to be further examined. Any knowledge gap needs to be addressed. Along with this, NPs should ensure that they are measuring and communicating the value they are already adding to healthcare.

Highlighting such values will not only give the needed confidence to NPs, but it will also encourage all the players to partner with NPs. Such partnerships will eliminate or drastically reduce the issue of lack of financial protections and payer partnerships.

In conclusion, for value-based healthcare to benefit from the nursing model, NPs must be proactive in making their voices heard and not be shy to blow their horns in this changing landscape.


1NHE Fact Sheet: U.S. Centers for Medicare & Medicaid Services

2The next frontier of care delivery in healthcare: McKinsey & Company

Nurse practitioner-owned practices and value-based payment: National Library of Medicine


Specializes in Primary Care, Long Term Care, Writing, Editing.
Alice Blackmore said:

I have never heard of the concept of value-based healthcare before. Just to clarify -- would insurance companies pay more because the patient's chronic condition improved or they got better? I see the benefit for physician payment but am wondering about kick-back from insurance companies.

Thanks for your comment, Alice. Providers/healthcare organizations share financial risk with the insurance companies, which makes it a good thing for the patient in my opinion. Yes, the sicker the patient, the higher the reimbursement and your coding plays a huge part in this. And yes, to some opponents' point it does reward providers. But in my experience, this has incentivized providers to be more engaged in educating, engaging, and empowering patients as members of the patient's care team. So, it's a win-win.

Specializes in Primary Care, Long Term Care, Writing, Editing.
NRSKarenRN said:

Value-based health care



CMS' Value-Based Programs | CMS - Centers for Medicare & Medicaid Services

Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of our larger quality strategy to reform how health care is delivered and paid for. Value-based programs also support our three-part aim:

  • Better care for individuals
  • Better health for populations
  • Lower cost

What are CMS' original value-based programs?

There are 5 original value-based programs; their goal is to link provider performance of quality measures to provider payment:

  1. End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
  2. Hospital Value-Based Purchasing (VBP) Program
  3. Hospital Readmission Reduction Program (HRRP)
  4. Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
  5. Hospital Acquired Conditions (HAC) Reduction Program

Are there other value-based programs?

There are other value-based programs:

  • Skilled Nursing Facility Value-Based Purchasing (SNFVBP)
  • Home Health Value Based Purchasing (HHVBP)


OJIN 2019  Affordable Care: Harnessing the Power of Nurses

Value-Based Care Elevates the Role of the Registered Nurse in Primary Care

NP Journal:  Value-Based Healthcare

ANA: Reducing Barriers to NP Value-Based Care

National Nurse Practitioner Entrepreneur Network (NNPEN): NP Value In Value-Based Care

Great information here. Thanks for sharing these links!

Specializes in Nephrology, Cardiology, ER, ICU.

Our practice utilizes a value based care approach. I'm in nephrology so my pts are very ill. We are provided with coding instruction so that we can capture charges for the care we already provide.