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4 Barriers to Implementing Value-based Payment Models

by Jasmine Pennic 01/17/2018 Leave a Comment

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Key Dates to Maximize Meaningful Use and MIPAA Incentive Payments Infographic

Majority of family physicians indicate their practices participate in value-based payment models and believe value-based payment models will encourage greater collaboration between primary care physicians and specialists, according to a new study. The 2017 Value-based Payment Study was sent to 5,000 active members of the AAFP. A total of 482 surveys were returned, and 386 were evaluated after a screening process. 

The study found that more and more family physicians are embracing value-based payment models, which is reflected in IT, care coordination and other investments. 

Key findings of the survey include:

– Acknowledging a connection between quality and payment. Thirty-seven percent of value-based payments distributed within a family physician’s practice are based on achieving quality and/or outcome measures, an increase from 18 percent as reported in 2015.

– Investing in care coordination as part of their approach to value-based payment models. Thirty-two percent of family physicians report that they provide ongoing care management/coordination services to all high-risk patients, an increase of 23 percent from 2015.

– Forty-three percent cite hiring/hired care management and care coordinators, compared to 33 percent in 2015.

– Earmarking more practice resources for value-based payment.Fifty-four percent of family physicians are in a practice that is updating or adding health IT infrastructure for data management and analysis to participate in value-based payment.

Barriers to Value-based Payment Models

The same barriers to navigating and implementing value-based payment models that the AAFP and Humana identified two years ago are still prevalent:

1. Lack of staff time (90 percent)

2. Lack of transparency between payors and providers (78 percent)

3. Lack of standardization of performance measures (78 percent)

4. No uniform insurance company reports on performance (75 percent)

As of September 30, 2017, Humana has 1.9 million individual Medicare Advantage members (out of 2.8 million total individual MA members) today who are cared for by approximately 51,500 primary care physicians, in more than 900 value-based relationships across 43 states and Puerto Rico.

Humana has approximately 66 percent of Humana individual Medicare Advantage members in value-based payment relationships. Humana’s total Medicare Advantage membership is approximately 3.3 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings.

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Tagged With: Care Coordination, Family Physicians, Value-Based Care, Value-Based Payment Models, value-based reimbursement model

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