How do value-based care models (e.g., capitated primary care, care navigation) fit into plan design?

Value-based care models focus on quality and outcomes instead of volume and claims. By paying providers to keep employees healthy rather than simply treating illness, these models improve engagement, lower costs, and stabilize long-term spending when integrated into plan design.

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What value-based care means in plan design
Traditional fee-for-service models pay providers per visit or procedure, which can lead to higher costs and fragmented care.

Value-based care reverses this approach by rewarding providers for prevention, chronic condition management, and better outcomes rather than the number of visits.

In practice, employers or health plans pay a flat, predictable fee (known as capitation) per member for primary care, allowing providers to take a proactive role in managing overall health.

Result: Fewer emergency room visits, lower total costs, and improved employee health outcomes.

Capitated or prepaid primary care stabilizes costs
With a capitated model, employers pay a flat monthly rate per employee for all primary care services—whether virtual, in-home, or in-office.

Why it works:

• Predictable and transparent costs.
• Unlimited access to care with no copays or deductibles.
• Prevention and early intervention that reduce major claims. 

Best for: Employers seeking predictable costs and higher employee engagement.

Care navigation improves outcomes and reduces waste
Care navigation helps employees find the right care at the right time and avoid unnecessary or duplicate services.

Benefits include:

• Guiding employees to cost-effective specialists and facilities.
• Reducing ER overuse and redundant testing.
• Simplifying the healthcare experience.

Impact: A better employee experience, higher satisfaction, and lower overall costs.

Integrating value-based care into your plan design
Value-based care can enhance almost any funding model, including MEC, HDHP, ICHRA, or level-funded plans.

How to integrate it:

• Add capitated primary care (such as Vitable) as the first line of care.
• Bundle preventive and chronic care services into a single flat fee.
• Use care navigation to direct employees to in-network or virtual specialists.
• Retain traditional coverage for high-cost, catastrophic claims.

Result: Improved care coordination and lower total costs without disrupting your existing structure.

Why employees value it
Value-based care replaces confusion and cost uncertainty with trust and simplicity.

• No surprise bills.
• Easy access to trusted providers.
• Personalized, proactive care that focuses on long-term well-being.

Outcome: Employees feel cared for, stay engaged, and cost trends remain stable over time.

Vitable’s primary-care-first model is built on value-based care principles. Every member receives $0 primary care, mental health, and prescription access, all coordinated through one seamless platform. Providers are incentivized to focus on outcomes, not volume.
By combining capitated primary care with proactive care navigation, Vitable helps employers:

• Improve utilization and engagement.
• Reduce ER and hospital use.
• Maintain predictable, transparent costs.

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Value-based care models, such as capitated primary care and care navigation, transform benefit plans by aligning incentives around prevention, simplicity, and measurable results. When integrated into your plan design through partners like Vitable, you can achieve healthier teams, steadier costs, and benefits that truly deliver long-term value.

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