Scorecard Shows Increased Adoption of Value-Based Payments
- Non-profit organization Catalyst for Payment Reform (CPR) released its 2014 National Scorecard for Payment Reform this week. The study examined commercial health plans, specifically looking at value-based payments versus traditional fee-for-service (FFS), bundled, capitated and partially-capitated payments without quality incentives.
According to the numbers, there has been a significant change in thinking over the last year. Currently, 40 percent of payments are designed to encourage healthcare providers to deliver higher-quality and more affordable care. In the 2013 version of the scorecard, the number was 29 percentage points lower. The organization had set a 2020 goal for 20 percent adoption, which has now been surpassed.
Suzanne Delbanco, Executive Director of CPR, said in a statement the demand on employers and their subsequent softening toward new payment methods can be seen in the new study.
“Now we have to start the next chapter: rigorous evaluation,” Delbanco said. “The tough question is whether these efforts are leading to better quality, more affordable care. We need to take a hard look at which models work to know which models to spread.”
Within the 40 percent, there are several interesting takeaways. Fifty-three percent of those using value-oriented payments put providers at some financial risk if they end up over budget or fail to improve quality of care. Shared-risk arrangements and bundled payments make up a very small percentage (1% and 0.1%, respectively), even though those these models have shown a strong potential to improve care and contain costs.
Value-oriented payments are affecting the healthcare industry as a whole, but to different degrees. For example, 38 percent of payments to hospitals are value-based. By comparison, 10 percent of payments for outpatient specialists and 24 percent of payments to all primary care physicians are value-based.
Another significant shift found between the 2014 and 2013 versions of the study revolves around patient members formally attributed to a provider with a payment reform contract. Last year, this number was at just two percent. In the current scorecard, the number increased to 15 percent.
Andréa Caballero, CPR’s Program Director who led the research on the scorecard, noted that there was surprise over the ability for pay-for-performance to jump over the last 12 months despite being around for nearly a decade.
“With today’s pressure to reform payment, health plans and providers are building on a method they know, despite limited evidence it improves care or saves money,” Caballero said. “If we hope to see advances in quality and affordability in the long-term, payers may need to take payment methods to the next level, pairing bonuses with financial risk to providers.”
This is another example of transparency becoming a bigger focus for medical payments. As we reported earlier this week, the Centers for Medicare & Medicaid Services (CMS) released the first round of its Open Payments data. The scorecard is the result of voluntary information submitted by commercial health plans to eValue8, the National Business Coalition on Health’s annual request for information to health plans. It represents 65 percent of the commercially-insured lives in the United States.
