Experts Respond to Healthcare Payment Reform Scorecard
- Earlier this month, this website examined the Catalyst for Payment Reform’s (CPR) 2014 national Scorecard for Payment Reform. It studied commercial health plans, specifically focusing on value-based payments versus the traditional fee-for-service method.
One of the biggest takeaway from the report is that 40 percent of private insurance payments are now considered “value-based.” This is well ahead of the goal of 20 percent of payments to hospitals and physicians being value-based by 2020 that CPR has been pushing for. The group defines value-based as any payment method that is designed to improve quality and reduce waste.
Now, some health care finance experts are starting to weigh in on the results.
According to Todd Nelson, the director of health care finance policy and operational initiatives for the Healthcare Financial Management Association, there was an expectation going in to the study that there would be an increase in the number of provider organizations that are using nontraditional payment arrangements instead of fee-for-service solutions. However, he did say that there is some skepticism about the results.
“As the study acknowledges, some of the potential explanation for the jump in responses could be due to a different pool of respondents from prior years, higher concentration of larger plans who may be more ready to leverage these types of arrangements, and the voluntary nature of survey participation, such that those that are actively pursuing payment reform were more likely to respond to those questions,” Nelson said.
He did go on to praise the study for the types of arrangements that providers consider and the need for health care stakeholders to collaborate and drive positive results under payment reform.
Suzanne Delbanco, the executive director of CPR, responded to the criticism and did note that the evidence on the ability to pay for performance to keep costs in check is “mixed” so far.
“Historically, the financial rewards may have been too small, and the focus of pay-for-performance programs may have varied too much by payer, resulting in weak and mixed signals to providers,” Delbanco said. “It may also be, however, that without financial ‘skin in the game,’ providers won’t change how they deliver care significantly. Clearly, there is more research to do.”
She added that value-based arrangements are not seeing the kind of penetration in some of the highest paid professionals in health care like specialists that has been seen in primary care physicians and hospitals. This could be happening because payment reform programs are not yet targeting specialty care and or these physicians are less eager to transition.
Regardless, progress is being made when it comes to payment reform as the fee-for–service model is phased out in favor of new payment models that are designed to improve quality and reduce waste.
