The impact of transition strategies from fee-for-service to value-based payment models on quality of care, patient outcomes, and healthcare costs: A systematic analysis

Abstract

The shift from fee-for-service (FFS) to value-based payment (VBP) models aims to improve healthcare quality, patient outcomes, and cost efficiency. Despite policy initiatives like the Affordable Care Act, challenges persist in implementation and equity. This systematic review followed PRISMA guidelines, analyzing 85 studies (2016–2023) from PubMed, Scopus, and Cochrane. Inclusion criteria encompassed randomized trials, cohort studies, and direct FFS-VBP comparisons, focusing on quality, outcomes, and costs. Risk of bias was assessed using the Cochrane and Newcastle-Ottawa tools. VBP models demonstrated cost reductions (e.g., 3.7% savings in Medicare’s bundled payments) and improved quality metrics like reduced readmissions. However, success varied by setting; integrated systems (e.g., Kaiser Permanente) outperformed rural hospitals due to infrastructure disparities. Key barriers included data fragmentation, provider burnout (reported by 40%), and difficulties in measuring value. While VBP models show promise, equitable adoption requires tailored strategies: risk-adjusted benchmarks, stakeholder engagement, and robust data systems. Policymakers must balance flexibility and accountability to achieve the Quadruple Aim. Future research should prioritize longitudinal studies and context-specific frameworks.