/Value-Based Care Contracting Report: Facing Challenges

Value-Based Care Contracting Report: Facing Challenges

While most stakeholders agree the shift toward value-based care is imminent, the current political environment and uncertainty surrounding healthcare reform have caused many healthcare organizations to slow or stall their efforts to prepare for risk-based medicine. 

Value-Based CareWhile many health systems continue to move toward value-based care, they face various challenges along the way, according to a survey conducted by The Health Management Academy.

The survey, sponsored by Lumeris, asked health system leaders about their respective organization’s journey toward value-based care. It involved an initial quantitative survey of 22 C-suite health system executives in 2016, as well as follow-up qualitative interviews with 12 of those executives.

Here are six findings.

  1. Seventy-three percent of the 22 executives said the transition from fee-for-service to risk-based care delivery models is a high or very high priority.
  2. Of the quantitative survey respondents, half participate in a Medicare ACO contract, 45 percent participate in a commercial ACO contract, and 41 percent participate in other risk-based contract(s) such as Medicare Advantage, state Medicaid, Medicare Part D, medical assistance and capitation.
  3. Eighteen percent of Medicare ACO contracts are meeting all health systems’ objectives, while 45 percent are meeting most objectives, the survey found. Thirty percent of commercial ACO contracts are meeting most health systems’ objectives, but none are meeting all objectives.
  4. The survey also found a majority of Medicare Advantage (63 percent), managed Medicaid (86 percent), and commercial/employee population health plan products (63 percent) are meeting all or most of health systems’ objectives.
  5. Follow-up interviews with the 12 executives showed health systems face various challenges to achieve success in value-based care. These include “aligning physician incentives with quality and cost goals,” “transforming care delivery,” “developing capabilities and expertise traditionally associated with payers,” and “collecting, aggregating and disseminating actionable data to drive clinical and financial performance.”
  6. According to the study, many participating health systems said they prefer for their organization to do its own work in building value-based programs and capabilities instead of partnering with an outside vendor.

While most stakeholders agree the shift toward value-based care is imminent, the current political environment and uncertainty surrounding healthcare reform have caused many healthcare organizations to slow or stall their efforts to prepare for risk-based medicine.

 

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