Docs taking on full risk in value-based care models still years away

March 18, 2019 / ALEX KACIK 

The healthcare industry is likely still several years away from assuming full risk in value-based payment models, according to a new survey.

A market in which the majority of value-based relationships include both upside and downside shared risk is three to five years off, according to nearly 40% of 185 healthcare executives surveyed by the HealthCare Executive Group and Change Healthcare. About 17% said it will take five or more years and 6% said it will never happen. These new payment programs seem perpetually stuck in a state of delay, researchers said.

Providers are participating in Medicare shared-savings programs, bundled payments and other new payment models. But adoption is slow. If they are implemented, they typically don’t have downside risk, and the providers aren’t on the hook for losses.

Limitations in data sharing, no agreement on outcome measures, and a lack of incentives for payers and providers to work together have stymied value-based agreement adoption. Payment reform has been on the survey’s top-10 priority list for 10 years, researchers noted.

Providers and insurers do not want to give their competitors an edge and have typically shied away from data sharing. The CMS has also sent some mixed signals related to voluntary or mandatory models, which may have slowed progress, said Dr. Andrei Gonzales, assistant vice president of value-based payments for Change Healthcare.

One survey respondent said there is misalignment in stakeholders’ primary objectives and how they operate and use clinical data. There are a number of attempts to move forward on a large scale, which is often too overwhelming to successfully implement, the respondent said.

“There is activity in value-based care, but what we see as the biggest challenge is provider engagement,” Gonzales said. “Providers need to understand how to be successful in value-based arrangements.”

Healthcare executives’ expectations follow the latest research. According to last year’s Moody’s Investors Services report, only 1.6% of not-for-profit and public hospitals’ net patient revenue came from capitation in 2017, inching up from 1.1% in 2013. Other risk-based payments only accounted for 1.2% of their revenue in 2017. Most reimbursement was still derived from diagnosis-related group payments, Moody’s data show.



Chris J. Stewart

Chris currently serves as Chief Operating Officer at Ortho Spine Partners. Prior to that, he was the assistant vice president and business unit leader of Medical Device Management for HealthTrust.

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