The shift from volume to value in U.S. healthcare is advancing, but not quickly enough, and not strongly enough to impact some key cost and quality indicators. That is the essential overall finding of the report released on Dec. 4 by the Berkeley, Calif.-based Catalyst for Payment Reform (CPR), in its new annual “2018 National Scorecard on Payment Reform 2.0,” which details the organization’s assessment of the shift into value-based care delivery and payment, and the financial and clinical outcomes associated with that shift.
Catalyst for Payment Reform, which describes itself on its website as “an independent, nonprofit corporation on a mission to help employers and other healthcare purchasers get better value for their healthcare dollar,” is supported by a consortium of large national healthcare employer-purchasers.
A press release published on the organization’s website began thus: “Today Catalyst for Payment Reform (CPR) released new and updated National Scorecards on Payment Reform finding the percent of payments to doctors and hospitals flowing through value-oriented or ‘alternative payment methods’ in the commercial sector grew from 10.9 percent in 2012 (when CPR first started tracking) to 53 percent in 2017. Additionally, CPR found that an overwhelming majority of value-oriented payment – 90 percent as of 2017 – is built on a fee-for-service foundation and just 6 percent of total dollars as of 2017 flowed through payment methods that pose downside financial risk to providers. This has been relatively consistent since 2012 when it was 5.7 percent.”
The press release quoted Robert S. Galvin, M.D., CEO, Equity Healthcare, and chair of the CPR board, as stating that “CPR was founded to catalyze payment reform that will transform health care. The results of these analyses are disappointing and a wake-up call that we are moving too slowly and essentially missing the mark. Not all payment reforms are equally effective and it’s time to put our energy toward payment methods that don’t rely on fee for service but, instead, empower health care providers to manage our populations and assume financial risk for their performance,” Dr. Galvin said in that statement.
As the press release noted, “The Scorecards examined data on the implementation of health care payment reform in the commercial sector in the United States for 2012, 2013, 2016 and 2017. Over that time, there was an early investment in pay for performance (12.8 percent of payments in 2014), but by 2016 shared savings payment arrangements (23.7 percent of payments in 2016, then 29.7 percent in 2017) were the most common type of payment reform. Bundled payment remained flat and in the low single digits throughout this period, representing 1.6 percent of dollars paid to providers in 2012 to 2 percent in 2017.”
What’s more, “Between 2012 and 2017, the rate of growth in payment reform was greatest at the beginning and has slowed in the most recent years of measurement. From 2012 to 2013 the amount of dollars flowing through value-oriented payment methods more than doubled from 10.9 percent to 27.1 percent. But from 2016 to 2017, the most recent year over year measurement available, the percent of dollars flowing through value-oriented payments only grew from 48.5 percent to 53 percent.”
Still, the report found, “While it is challenging to measure how many Americans with commercial insurance have been touched by payment reform, CPR tracked the percent that generally receive their care from a provider with a payment reform contract. This steadily increased from 2 percent in 2012 to 24 percent in 2016 (the most recent year for which data are available). This figure is based on the patient population commercial health plans attribute to a provider to calculate health care costs/savings or quality of care scores. “Attributed” patients can include those who choose to enroll in, or do not opt out of, an accountable care organization, patient centered medical home, or other delivery models in which patients are attributed to a provider.”
Cost and quality outcomes
When it comes to the affordability of U.S. healthcare, the CPR study found the following:
Ø In 2013, 7.45 percent of patients with commercial health insurance were unable to receive care due to cost concerns.
Ø In 2016 and 2017, 9.48 percent and 9.68 percent, respectively, of patients with commercial health insurance were unable to receive care due to cost concerns.
“Given the growing recognition that high prices are the major reason health care costs continue to rise while the use of services remains flat, CPR’s view now is that it’s not real payment reform if it doesn’t address prices,” said Suzanne Delbanco, PhD, CPR’s executive director, said, in the press release.
Regarding the quality of care, the press release noted that:
“There were small upticks between 2012 and 2017 in the percent of commercially insured patients with diabetes who had their blood sugar measured with HbA1c tests (88.7 percent in 2012 and 90.49 percent in 2017), in the percent of patients given instructions on how to recover at home (85 percent in 2012 to 87 percent in 2017) and in the percent of children receiving recommended vaccinations (68.4 percent in 2012 to 70.4 percent in 2017). At the same time, however,” the press releasee noted, “there were small increases in commercially insured patients with diabetes who had poorly controlled blood sugar (31.38 percent in 2012 to 36.44 percent in 2017), hospital-acquired pressure ulcers (21.7 patients in the general patient population out of every 1,000 in 2014 to 23 out of every 1,000 in 2017), and cesarean sections among women with low-risk births in the general patient population stayed constant.” Meanwhile, “Readmissions remained flat between 2012 and 2017 – 8.2 percent of commercially insured patients admitted to the hospital are readmitted within 30 days.”
