A group of major payers and providers said its member organizations have more than half their business tied to value-based payment arrangements in 2018, while aiming to hit the 75% mark by the end of next year.
The Health Care Transformation Task Force announced on Tuesday that 42 member organizations had 52% of their business in payment arrangements involving global budgets, bundled payment or shared savings deals by the end of 2018, up to 47% the year before.
That's despite widespread concerns that providers and plans have moved more slowly than hoped into value-based arrangements which strongly incentivize performance improvement, including downside financial risk for failing to meet cost and quality targets.
Most policymakers and experts say substantially shifting healthcare payment from fee-for-service to robust value-based contracts is essential for controlling U.S. healthcare spending and improving quality of care.
"Task force members have made important and impressive progress in moving the dial on value-based payment adoption," Fran Soistman, executive vice president at Aetna and chair of the task force, said in a written statement.
The task force members include Aetna, Anthem, Ascension, Blue Cross Blue Shield of Michigan, Cleveland Clinic, Dignity Health, Geisinger, Pacific Business Group on Health, Sentara Healthcare, and Trinity Health.
The group defines value-based payment arrangements as those that successfully incentivize and hold payers and providers accountable for the total cost, patient experience and quality of care for a population of patients, either for that population's full range of care or for defined episodes.
One large task force member acknowledged that achieving the 75% goal for value-based payment will be a stretch.
Emily Brower, senior vice president for clinical integration at Trinity Health, said her system now has 24% of its business in alternative payment models, covering 1.6 million people. "We think of it as aspirational for us to go from 24% to 75%," she said.
Trinity has been aggressive in participating in Medicare and Medicaid accountable care and bundled payment programs. But it has made slower progress with Medicare Advantage and commercial health plans. She said Trinity is in conversations with most of the local and national health plans about moving to alternative payment models.
"Commercial payers are in different positions, just like providers," she said. "We need to work with health plans to come up with those models, and that takes more time."
Jeff Micklos, the task force's executive director, said that while some task force members already have achieved the 75% goal, many are facing obstacles in reaching that threshold. "Value transformation has been incremental so far and is not moving as fast as many would like," he said.
While the number of value-based payment deals is increasing, many don't include strong mechanisms to change behavior, including downside risk. Providers and health plans frequently complain that the other side in the negotiations isn't interested in entering into robust value-based payment contracts.
The lack of timely, accurate claims data and valid quality data is often cited by providers as a major obstacle to entering deals with downside risk.
"If the data (aren't) accurate, you're not going to get provider buy-in, and you're not going to get clinical change," Dr. Brian Klausner, chief medical officer of WakeMed Key Community Care, told Modern Healthcare last month.
Brower stressed that her organization is eager to move forward with value-based payment because it produces better care for patients.
"When we're paid to be accountable for the full experience and clinical outcomes, the team is all working around one patient care plan, and people feel that care very differently," she said.
