Subscribe to RSS
DOI: 10.1055/a-2576-5561
Reimagining Neurological Care: A Value-Based Approach

Abstract
Value-based care has been impactful in primary care, but specialty care has not been a large focus area. This manuscript provides neurologists with an overview of value-based payment (VBP) models and offers practical suggestions for engaging in these models using example conditions of migraine and dementia. The article discusses various VBP models, from low-risk pay-for-performance to high-risk shared risk models, and emphasizes the importance of data infrastructure, patient outcomes, quality improvement, and cost reduction for success in value. By adopting a value-based approach, neurologists can improve care for complex neurological conditions, enhance patient satisfaction, and achieve sustainable health care excellence. The conclusions highlight the transformative potential of VBP models in neurology, encouraging neurologists to take small steps toward value-based care to achieve quadruple aim benefits.
Publication History
Accepted Manuscript online:
08 April 2025
Article published online:
01 May 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Smith TM. What is value-based care?. These are the key elements. American Medical Association. August 8, 2024. Accessed March 18, 2025 at: https://www.ama-assn.org/practice-management/payment-delivery-models/what-value-based-care-these-are-key-elements
- 2 Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014; 12 (06) 573-576
- 3 Verma S. 2019 Medicare Shared Savings Program ACO performance. Health Affairs Forefront. September 14, 2020. Accessed March 18, 2025 at: https://www.healthaffairs.org/content/forefront/2019-medicare-shared-savings-program-aco-performance-lower-costs-and-promising-results
- 4 King R. Physician-led ACOs generated almost 7 times more savings than hospital-led ACOs: Avalere. Fierce Healthcare. Accessed September 12, 2023 at: www.fiercehealthcare.com/payer/physician-led-acos-generated-almost-seven-times-more-savings-than-hospital-led-acos-avalere
- 5 Cohen K, Ameli O, Chaisson CE. et al. Comparison of care quality metrics in 2-sided risk Medicare advantage vs fee-for-service Medicare programs. JAMA Netw Open 2022; 5 (12) e2246064
- 6 American Academy of Family Physicians. Value-based payment models for primary care (Position Paper). September 2024. Accessed March 18, 2025 at: https://www.aafp.org/about/policies/all/payment-models.html
- 7 McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL. Early performance of accountable care organizations in Medicare. N Engl J Med 2016; 374 (24) 2357-2366
- 8 CMS Shared Savings Program. Program guidance and specifications: quality. Centers for Medicare and Medicaid Services. Accessed December 18, 2024 at: https://www.cms.gov/medicare/payment/fee-for-service-providers/shared-savings-program-ssp-acos/guidance-regulations#quality
- 9 Cohen F, Brooks CV, Sun D. et al. Prevalence and burden of migraine in the United States: a systematic review. Headache 2024; 64 (05) 516-532
- 10 Buse DC, Yugrakh MS, Lee LK, Bell J, Cohen JM, Lipton RB. Burden of illness among people with migraine and ≥ 4 monthly headache days while using acute and/or preventive prescription medications for migraine. J Manag Care Spec Pharm 2020; 26 (10) 1334-1343
- 11 Silberstein SD, Dodick DW, Aurora SK. et al. Per cent of patients with chronic migraine who responded per onabotulinumtoxinA treatment cycle: PREEMPT. J Neurol Neurosurg Psychiatry 2015; 86 (09) 996-1001
- 12 Ailani J, Burch RC, Robbins MS. Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache 2021; 61 (07) 1021-1039
- 13 Corasaniti MT, Lawrence GW, Bagetta G. et al. Combination of anti-CGRP/CGRP-R mAbs with onabotulinumtoxin A as a novel therapeutic approach for refractory chronic migraine: a retrospective study of real-world clinical evidence and a protocol for a double-blind, randomized clinical trial to establish the efficacy and safety. Front Pharmacol 2023; 14: 1296577
- 14 Leonardi M, Raggi A. A narrative review on the burden of migraine: when the burden is the impact on people's life. J Headache Pain 2019; 20 (01) 41
- 15 Kosinski M, Bayliss MS, Bjorner JB. et al. A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res 2003; 12 (08) 963-974
- 16 2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20 (05) 3708-3821
- 17 Ma D, Wang Y, Zhao Y. et al. How to manage comorbidities in people with dementia: a scoping review. Ageing Res Rev 2023; 88: 101937
- 18 Guiding an Improved Dementia Experience (GUIDE) Model. Centers for Medicare and Medicaid Services. Accessed December 19, 2024 at: https://www.cms.gov/priorities/innovation/innovation-models/guide
- 19 Calendar Year (CY) 2025 Proposed and Modified Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) CMS Quality Payment Program Website. Accessed December 17, 2024 at: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2877/2025-Proposed-and-Modified-MVPs-Guide.pdf
- 20 Chen AJ, Li J. Paying for advance care planning in Medicare: impacts on care and spending near end of life. J Health Econ 2024; 98: 102921
- 21 Weissman JS, Reich AJ, Prigerson HG. et al. Association of advance care planning visits with intensity of health care for Medicare beneficiaries with serious illness at the end of life. JAMA Health Forum 2021; 2 (07) e211829
- 22 Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001
- 23 Sylvia ML, Vigil IM. Population Health Analytics. Burlington, MA: Jones and Bartlett Learning; 2022
- 24 Aranda MP, Kremer IN, Hinton L. et al. Impact of dementia: health disparities, population trends, care interventions, and economic costs. J Am Geriatr Soc 2021; 69 (07) 1774-1783
- 25 Walsh SC, Murphy E, Devane D. et al. Palliative care interventions in advanced dementia. Cochrane Database Syst Rev 2021; 9 (09) CD011513