Health systems are embracing value-based care: survey

Ninety percent of payers and 81% of providers now use some mix of VBR combined with fee-for-service.
Ninety percent of payers and 81% of providers now use some mix of VBR combined with fee-for-service.

Pharmaceutical companies targeting healthcare stakeholders with “beyond the pill” strategies may find physicians increasingly busy and out of reach as accountable care models accelerate at a surprising clip with payers and hospitals.

As healthcare systems align behind a spectrum of different value-based reimbursement (VBR) models, clinician buy-in will be a key challenge to the models success in lowering costs and improving outcomes, according to a survey on the state of VBR development in the US by McKesson Health Solutions (MHS) and research firm ORC International.

Lack of clinician engagement was named as the top concern by senior executives at 115 payers and 350 providers-- hospitals and hospital systems--in a survey covering a representative sample of stakeholders based on geography and institution size.

“Clinician involvement was identified as a critical component by all respondents. Practitioners have to understand the reason for VBR and be willing to go through the change,” says Dr. Andrei Gonzales, director of value based reimbursement initiatives at MHS.

“It's a big challenge as the clinicians have many competing priorities. Picking up these new payment models requires a lot of administration work, new approaches with technology and, as the care delivery changes, managing relationships  between health plans, providers, and patients,” he adds.

VBR adoption is forecast to grow in increments over the next five years, albeit with no universal model in place. Healthcare entities have taken up a half-dozen different models in which some of the risk for managing a patient is transferred to the provider, with incentive to the provider to manage the patients care.

Ninety percent of payers and 81% of providers now use some mix of VBR combined with fee-for-service. “There is no single way to do this. We haven't proven the VBR model that works today,” Gonzales says.

As value-based care supplants fee-for-service (FFS), the survey shows a “remarkable alignment” between what provides and payers expect in the evolution of the payment model mix, says Dana Benini, VP, ORC International.

Pay-for-performance is forecast to see the most growth over the next five years at 8%, followed by the episode of care/bundled payment approach at 6%, as FFS corresponding with the growth of VBRs declines 24% over the next five years.

Valued-base care with some form of value measurement will make up two thirds of the market by 2020, up from one third today.

The challenge of practitioner buy-in underscores the need for tools that enable clinician engagement with VBRs. Existing healthcare IT infrastructure is an obstacle and next gen healthcare IT is needed for integrating complex reimbursement models and enabling transparent data sharing among payers, providers and patients.

For payers, tools to help clinicians understand and measure performance have the highest urgency;  providers are primarily looking for tools to understand the financial  impact of care decisions, Benini reports.

“All of the large players have this technology in place today. Many of the small to medium stakeholder are less sophisticated, but the majority plan on implementing new technology in the next two to five years, Benini says.

“Many of us who have been in the industry a long time talking about VBR were fairly surprised by the pace of change that is anticipated by these senior level executives given the amount of change these institutions are navigating now. We recognize these new payment models are associated with a lot of challenges,” she adds.