While healthcare providers are speeding ahead with implementing value-based payment models to reduce admissions and save costs, some slow-to-adapt commercial insurers are hindering progress, according to a survey of health system executives.
Because insurers in many states have been slow to form value-based payment agreements with integrated delivery systems and clinical networks, 66.7% of hospital C-suite leaders are becoming more interested in starting or pairing up with a provider-owned health plan rather than waiting on insurers to partner up, according to the survey released Wednesday by healthcare group purchasing and quality consulting firm Premier (PDF).
“Folks are eager to move into commercial risk-bearing contracts for the purposes of MACRA, and it is slow going in many, many markets,” said Bryan Smith, principal at Premier, referring to Medicare's new physician incentive payment system. While there is some movement toward value-based arrangements and contracts, to be successful, the contracts need to include requirements for sharing data, among other things, he said.
Out of frustration, providers are looking at setting up their own health plans so they can “capture the savings” they are delivering by improving care through models like accountable care organizations, instead of watching those savings end up in insurers' pockets, said Blair Childs, senior vice president of public affairs at Premier.
Charlotte, N.C.-based Premier surveyed 60 health system C-suite executives online in June and July to gauge the success of value-based partnerships between providers and payers and find out what services payers are offering providers to enable the shift to value-based arrangements.
The survey found that just 28.8% of providers said they participate in shared savings contracts with commercial payers, despite the fact that providers are accountable for shifting to a value-based system in order to maximize Medicare through pay-for-performance plans, Premier said.
In addition, 13.6% of providers said payers are investing to help build the infrastructure needed for value-based arrangements, including helping physicians fund electronic health record systems, the survey showed.
Twenty-two percent of providers said payers are sharing insurance claims for analysis to better manage care costs and quality; 28.8% said payers are providing transparent, quarterly updates on efficiency and quality performance; and 25.4% said payers are offering education on emerging alternative payment models, MACRA and HCC, or Hierarchical Condition Category, scores, according to the survey.
About one-third of C-suite leaders surveyed said insurers are helping identify high-risk patients for care interventions, but only 13.6% said insurers are developing value-based health plans for high-risk patients. About 30% of those surveyed said payers are establishing shared goals and measures of success.
At the same time, 45.8% of providers said they are working more closely with insurers on coordinating care, while 42.4% said they are providing incremental payments to primary care physicians for care management.
While providers are eager to participate in value-based arrangements, they need access to data, shared savings and potential upfront investments in setting up the programs, all of which are elements of an effective partnership, Childs said.
“It's the depth of the partnership that's really important and that's what our members would like to see more of,” he said.
“Folks are anxious about this,” Smith said.
Physicians are supposed to start reporting performance data under MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, next year. The payments kick in in 2019.
To avoid penalties under MACRA, providers must participate in the Merit-based Incentive Payment System, or MIPS, or another alternative payment model. Physician payments will be based on several quality measures and the use of EHRs. Experts say many physicians, especially those in smaller and rural practices, won't be ready to report. The final rule is expected to be finalized by Nov. 1.
