Survey Highlights Progress, Persistent Barriers on Value-Based Care Journey
NAACOS, the National Association of ACOs, and Innovaccer, a company that has developed an interoperability platform for value-based care (VBC), have released a survey of healthcare professionals about their progress on value-based care transformation. Healthcare Innovation spoke with NAACOS CEO Emily Brower and Innovaccer co-founder and CEO Abhinav Shashank about the survey results.
The survey respondent pool of 168 healthcare professionals was composed primarily of executive leaders (52%) and clinical leaders (19%). They represented functional areas including clinical operations (38%), population health management (23%), and financial strategy (16%).
Here are some bullet-point highlights:
• 30% of organizations reported that 25% or more of their revenue is tied to VBC contracts.
• More than 60% of organizations have increased their participation in VBC programs.
• Nearly 20% of organizations report that over half of their revenue comes from fully capitated or downside risk contracts.
• Barriers to adoption cited by respondents include financial risk, provider resistance, lack of data interoperability and the cost of technology to facilitate VBC.
• Those surveyed cited greater financial support, improved data sharing capabilities with payers and clearer regulatory guidelines as factors that would greatly support VBC adoption.
Healthcare Innovation: Emily, what are some of your take-aways from this survey?
Brower: I think it's an important topic. We're sort of at a place of maturity within accountable care and value-based payments where accountable care organizations, our members, are moving beyond the foundational work of understanding data, ingesting data, slicing and dicing data in order to segment their population, understand their needs clinically, understand who they are demographically.
Many people have figured out how to integrate that data. They've even figured out how to get data from all those disparate electronic health records that their network uses. So they have solved a lot of that at scale. It has become relatively affordable to do that, whereas you couldn't put enough muscle into it in the early days, and the cost of those tools was higher. So I think we are at a different level of maturity now, where people understand the different data sources. And now there are tools that are more affordable and with greater levels of interoperability.
Healthcare Innovation: The top line numbers in the survey are that 30% of organizations reported that 25% or more of their revenues are tied to value-based care contracts, and 60% said that their organizations have increased participation in value-based care. Do you think that that the pace of change there is encouraging or still not moving fast enough?
Shashank: Given that Medicare has said that by 2030 they want all their payments to move toward value-based care. I think there is catching up to do. It needs a bunch more acceleration. I think we need to ask what are the hindrances? If we want healthcare organizations to move toward this, what's blocking them? The progress is incredible, but there is a ton more work to be done.
HCI: One of the findings in the study was that nearly 20% of organizations report that over half the revenue comes from fully capitated or downside risk contracts. That seems to signal advancing maturity of adoption. But does that 20% number need to move much higher?
Brower: Your foot's heavy on the pedal when you've got downside risk, but nobody's going to take a flyer, right? The contract terms have to be fair. You have to have the full unblinded claims data set. Everything has to be set up in a way that it's reasonable and responsible for you to take downside risk. In the Medicare programs, there's a whole pathway toward that. You're getting all the claims data right from the start, and you have time to work with it before you move along into downside risk. And I think probably many commercial value-based payment arrangements are like that, too. So yes, the data tells you that the results are better in full risk, but it has to be reasonable.
HCI: When we look at the list of barriers highlighted in the survey, such as financial risk, provider readiness, lack of data interoperability, and technology cost, it occurs to me that a survey from five years ago would have highlighted similar barriers. On the data interoperability issue, are we seeing some improvement there, or does something else need to happen to make that data flow better?
Shashank: I think TEFCA has basically been like a step in the right direction. Also, no one can actively block information access today, right? If we rewind back six or seven years, I don't think that was clear. So I think we've definitely made progress or interoperability, and if someone is actively blocking information access, they know they are going to be in trouble, right?
Brower: I would say there has always been a lot of muscle being applied to identifying and finding and adjusting data sources. Now people are looking at FHIR and interoperability tools and saying, ‘Oh, now I think I'll be able to to get that data.’ I feel like we're on the cusp of something with tools that are now more affordable and people getting access to them through an MSO or a population health services company.
HCI: In the survey, 59% said they want to see greater data sharing capabilities with payers. Have you seen progress on that front — that there's more data flowing between the providers and payers?
Shashank: Very little. They have made progress with informational flow from the providers to the payers, but in return, they're also asking for the payers to be more transparent. There have been rulings around prior authorization that they need to respond in a certain time frame. I think all of these are steps in that direction, where information flow across these organizations will create a meaningful upside for everyone.
Brower: I've had the good fortune to work with healthcare delivery organizations that are pretty advanced on that journey, so they were getting full unblinded claims data sets from payers, and doing the muscle work to load and align those data sets. I think there's a general understanding now that you can't take accountability for total cost of care and outcomes for a population without the full unblinded claims data set.
In early days, whether it was a true lack of understanding around what were the rules around sharing PHI or a convenient excuse to not share data, there was a lot of confusion and concern about compliance and privacy, right? But we're past that. Everybody knows now that there is no concern about giving an ACO entity full unblinded claims data sets.
HCI: Another barrier cited often is lack of standardized quality metrics. So could more work on streamlining the metrics and and multi-payer alignment alleviate some of that concern on the providers?
Shashank: Yes, especially in commercial contracts. Medicare is far more streamlined and that is where you see people making a lot more progress in value-based care. Value-based care is about improving outcomes, and unless we can define outcomes in a standardized way, value-based care will continue to feel like a cottage industry, rather than like the industrial scale we are pushing toward.
HCI: The survey asked about where they're investing resources, and 50% said data analytics and AI; 48% said care management technologies; and 33% said patient engagement solutions. Were there any surprises there to you? It seems to me like you'd need a combination of all three of those to succeed.
Shashank: It does. The thing we have been talking about with our customers is that these are not separate things. You need to know which patients to interact with and you need to engage them. That's the crux of what you want to do here, right? What you really want is a precise way to engage your patients on a regular basis.
My general sense is where people have struggled is that they have looked at this in a siloed way and created a separate data warehouse. Now that data warehouse does not talk to your care management application or your provider engagement application. They are not completely integrated or interoperable with other systems. We are seeing new customers who are realizing that they need this integrated value-based care delivery technology.
Brower: I think ACOs tend to be more sophisticated in how they take in data and use it for population management, cost management, site-of-service opportunities, care management transitions. They're doing all those things. When people say we need to harness all this data out there and get it to the point of care, I think ACOs are doing that and they started with whatever data they could get their hands on. I think ACOs are a lot more sophisticated on the data front.
