A Healthcare Financial Management Association (HFMA) study sponsored by Humana finds continued progress for value-based care and interoperability, yet key barriers remain:
- Adoption of payer value-based programs may be somewhat slower than expected, though they have doubled since 2015.
- External and internal interoperability may be a primary focus of providers in the coming years, due to current shortcomings, anticipated future need, and the increasing demand for access to various sources of data.
- Almost three-quarters of executives (74%) report their organizations have achieved positive financial results (i.e., return on investment) from value-based payment programs to date.
Transformation of the nation’s healthcare payment system is being slowed by limited capabilities for sharing clinical information among hospitals, physicians, and health plans, according to a study conducted by the Healthcare Financial Management Association (HFMA) and sponsored by Humana. The study surveyed senior financial executives about their organizations’ value-based payment readiness.
Nearly three in four (74%) of executives surveyed in this follow-up study cite interoperability, the need to improve capabilities for aggregating clinical information across networks and between hospitals and physicians, as an extremely important need. Concerns about interoperability have increased since the original study was conducted in 2015. That study found 68% of respondents rated interoperability as an extremely important need at that time. Additionally, half of respondents in the 2017 study describe interoperability improvement across health networks with health plans as extremely important.
The results are also similar to a study by the American Academy of Family Physicians, sponsored by Humana, which found that value-based care continues to make progress but faces challenges. Researchers also found that value-based payment adoption among healthcare providers has increased and return on investment (ROI) has improved since the original study was conducted in 2015.
Highlights of findings from the 2017 study include the following:
- Health plans’ use of value-based mechanisms has increased from 12% to 24% since 2015. In 2015, however, utilization of value-based mechanisms by health plans was projected to reach 50% in 2018.
- Penetration of value-based payment in negotiated governmental plans (i.e., Medicare Advantage and managed Medicaid plans) came in at 26% in 2017, compared to 21% in traditional Medicare and 14% in non-managed Medicaid plans.
- Seventy-four percent of respondents report their organizations have achieved positive financial results from value-based payment programs to date. This is higher than the 51% of executives reporting positive financial results in 2015.
- About three-quarters of respondents stated that regulatory uncertainty, including MACRA, has a negative effect on their ability to forecast the financial impact of value-based payment. MACRA, the Medicare Access and CHIP Reauthorization Act, encourages physicians and other eligible professionals to participate in alternative payment models that would hold them accountable for quality and cost of care.
Beyond limited ability to access, collect, and manage clinical data, respondents also note the following as significant challenges related to value-based payment:
- Lack of resources (both staffing and financial resources)
- Inconsistencies among payers (i.e., measures, access to data from payers, contracting)
- Lack of physician alignment and support
