Understanding Value-Based Care: What Medicare Agents Need to Know

The Shift Toward Value-Based Care

On this episode of Insurance Business Babes, host Kathe Kline sat down with Dr. Shannon Decker, a healthcare veteran with over two decades of experience in Medicare Advantage and value-based care. As plans evolve and the Centers for Medicare & Medicaid Services (CMS) push for more risk-bearing arrangements by 2030, the industry faces a monumental shift from traditional fee-for-service models to value-based care. But what does this really mean for agents, doctors, and clients?

What Is Value-Based Care?

Traditional healthcare often paid doctors based on the number of visits or services ("fee-for-service"), which incentivized volume over outcomes. Value-based care, as Dr. Decker explains, flips the script. Doctors and healthcare organizations are compensated for keeping patients healthy, focusing on prevention, timely screenings, and disease management—rewarding better outcomes rather than more appointments.

For example, managing chronic conditions like COPD or diabetes proactively can prevent costly hospitalizations and complications, leading to both healthier patients and more efficient care.

How Does It Affect Agents and Clients?

Kathe shared concerns many agents have: will value-based care mean decreased benefits for clients? Decreased compensation for Doctors? Dr. Decker reassures that, done right, agents can add more value. Agents play a crucial role by guiding clients to plans with the best-suited preventive care benefits and by encouraging clients to utilize free screenings and annual wellness visits.

Encouraging clients to participate in these preventive services isn’t just good for health outcomes—it supports plan quality, helps doctors earn appropriate compensation, and improves client retention. "You might be saving your client's life,” Kathe notes, emphasizing the power of regular screenings.

Advice for Insurance Agents

Dr. Decker encourages agents to educate clients on available benefits and to build relationships based on trust and advocacy. Knowing which plans offer robust care management and preventive services—like nutritional counseling or group education—helps agents set themselves apart. The more clients understand the “why” behind recommended screenings, the more likely they are to engage, which has a positive ripple effect for everyone involved.

Final Thoughts

The future of Medicare hinges on value-based care models that prioritize prevention and patient outcomes. Agents who embrace this shift by advocating for screenings, wellness visits, and proactive self-care will be invaluable partners to both clients and providers as the industry evolves.

This episode is sponsored by ⁠CertifiedMedicareAgents.com⁠. Use the coupon code BABES2024 for a free lifetime BRONZE membership.