How to Achieve Value Within the Value-Based Care Transition
By - The Department of Health and Human Services (HHS) is on a mission to associate 90 percent of Medicare payments to value within the next three years and Congressional passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The pendulum may even be swinging into the realm of value-based care much more quickly than initially supposed, with data showing significant increases in value-based revenue for hospitals. Financial questions are nonetheless emerging as time passes for some in the healthcare industry.
Although active demand regarding value-based payments among healthcare policymakers is still going strong, the simple idea of how to effectively attain such value is often an ignored concept, according to a recent White Paper survey from the American Medical Group Association (AMGA). Multispecialty medical groups (MSMGs) and integrated delivery systems (IDSs) anticipate a nearly one-quarter decrease in fee-for-service (FFS) payments over the next two years, confirms AMGA within a press release. Nonetheless, “barriers are slowing the transition to value-based care.”
AMGA says its September survey of 115 respondents from over 100 medical groups aims to utilize captured data to address issues related to the ongoing evolution of healthcare financing and to more fully comprehend present hindrances and opportunities in relation to provider risk. Says AMGA, the survey resultantly confirmed a “definite” transition away from fee-for-service payments toward risk-based payment participation.
Respondents identified the impediments to taking risk and clarified what is required to meet goals from Congress and the Department of Health and Human Services (HHS) within the ongoing transition from volume to value-based payments.
Highlights of AMGA’s key survey findings
- The most significant apprehensions for commercial insurers include restricted accessibility to administrative claims data, deficiencies in cost and quality data transparency, and strong concerns regarding standardized data submission
- Twenty-two percent of survey respondents claim they were not offered risk-based products within their market
- Nearly half of respondents say up to 19 percent of insurers were proposed the choice of risk-based arrangements in their market
- Over 40 percent of respondents claim they require between 3 and 5 years before they are able to accept downside risk; 17 percent claim they require at least 6. Says AMGA, “This demonstrates that transitioning to risk may take longer than policymakers anticipate.”
- Commercial Accountable Care Organization (ACO) revenues may double within the next 2 years. Revenues from value-based ACOs and Medicare Advantage are projected to increase by up to 36 percent
“Our members understand the importance of transitioning to a value-based payment system, in fact many are already moving in that direction,” says Chester A. Speed, JD, LLLM, Vice President, Public Policy at AMGA. “This transition will be challenging and medical groups need policymakers and commercial insurers to partner with them to offer the tools they need to be successful in a new risk environment. We at AMGA look forward to working with Congress, HHS, and the commercial sector to implement the strategies that will drive success in a value-based healthcare system,” Speed states.
Healthcare providers will need to adequately handle risk within the next several years to stay afloat, confirms Speed and Nikita Stempniewicz, Research Associate, Grant Couch, and Director of Government Relations with the American Medical Group Association, within the White Paper. Both maintain it is not yet known whether or not the transition from volume to value will result in seamless execution.
“If policymakers want to successfully transform the current volume-based payment system to one based on value, they need to understand these impediments to risk-taking and offer the tools providers need to make this transition successful,” write Speed and Stempniewicz. “If these issues are overlooked, the opportunity to reform the system for both the benefit of patients and programmatic efficiency may be lost.”
