Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Key Providers, Payers Tie 47% of Business to Value-Based Payment

The Health Care Transformation Task Force inched closer to its goal of having 75 percent of business under value-based payment models by the end of 2020.

Value-based payment

Source: Thinkstock

By Jacqueline LaPointe

- A large group of major healthcare payers and health systems are reporting that nearly half of their business rests in value-based payment arrangements.

The Health Care Transformation Task Force (Task Force) is a group of leading healthcare payers, providers, purchasers, and patient organizations. The Task Force launched in 2014 to bring healthcare stakeholders together to act as a private sector driver, coordinator, and facilitator of delivery system transformation.

Major members of the Task Force include Aledade, Atrius Health, Geisinger, Ascenion, Partners HealthCare, and the Cleveland Clinic. Aetna, Anthem, and several Blue Cross Blue Shield organizations also participate in the Task Force.

The group of major healthcare stakeholders set a goal of having 75 percent of their respective businesses operating under value-based payment arrangements by the end of 2020.

And members of the Task Force are well on their way to achieving their goal, according to a new announcement. The Task Force announced that its provider and payer members converted 47 percent of their businesses to value-based payment by the end of 2017.

The percentage of business attributed to a value-based payment arrangement also increased from 41 percent in 2016 and 30 percent in 2015.

“There is growing evidence that value-based care leads to better health, better care, and reduced total cost. That’s why our members remain focused on reaching the goal of 75 percent by 2020,” Fran Soistman, Executive VP and Head of Government Services with Aetna and the Task Force’s Chair, stated in the announcement. “This report demonstrates Task Force members’ commitment to accelerating the pace of transformation toward value-based care across the health care continuum.”

The shift away from fee-for-service to value-based payment has been a slow, but steady journey.

Only about one-third of healthcare payments made across the industry were tied to an alternative payment model in 2016, according to the latest data from the Health Care Payment Learning & Action Network (LAN).

Overall, providers have been apprehension about the transition away from the traditional fee-for-service model. Fee-for-service provided a stable source of revenue for providers, while value-based reimbursement is tied to provider performance on cost, quality, and a handful of other quality metrics.

About 61 percent of doctors still fear value-based reimbursement will damage their practice, and another 49 percent believe the alternative payment model will negatively impact patient care by increasing administrative burdens.

The federal government has been working with providers to meet them at their own pace.

“The government has put programs in place that encourage behavior change at a pace compatible with the most reluctant provider,” explained Michael Abrams, Co-Founder and Managing Partner at Numerof & Associates.

For example, CMS implemented several transition years for the new Quality Payment Program to ease providers into the new reporting and payment requirements.

But HHS is now determined to accelerate the transition to value-based payment. In a March 2018 speech at the Federation of American Hospitals’ Annual Public Policy Conference, HHS Secretary Alex Azar said that rising healthcare costs require the industry to take the leap into value-based care and payment.

“In fact, the only option is to charge forward — for HHS to take bolder action, and for providers and payers to join with us,” he said. “This administration and this President are not interested in incremental steps. We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests.”

CMS has already proposed to alter its largest Medicare accountable care organization (ACO) program to accelerate the transition to risk-based payments.

The proposed changes earned industry pushback. But providers and payers may be more open to taking on value-based reimbursement as more organizations report the clinical and financial benefits.

Humana recently reported that its value-based payment arrangements reduced medical costs by 15.6 percent compared to its fee-for-service population, and the arrangements improved care quality, boosting services like preventative care.

“The transition to value is a challenging journey, and much work lies ahead,” said Jeff Micklos, HCTTF’s Executive Director. “While the uncertain landscape in 2017 around value-based care impacted overall performance, we’re pleased to see our members continue the forward momentum.”


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