Health plans are struggling with value-based reimbursement (VBR) due to internal and external barriers are hampering payers’ adoption of value-based programs, according to a new survey by HealthEdge and Survata. The survey reveals that for payers to have a significant chance at success with VBR programs, they must have modern and flexible technology systems that can easily collect and share data, quickly test and model new programs, and are designed to build more trust among providers of all types.
Survey Background
Similar to HealthEdge’s 2018 studies, HealthEdge — in partnership with market research firm Survata — conducted a survey of more than 150 health insurance executives to understand payer experiences with VBR. The goal was not only to understand the challenges associated with rolling out these initiatives but also to uncover which strategies are garnering success and what barriers still stand in the way.
“Our survey shows that, in order for value-based reimbursement programs to work as intended, health insurers first need trust and alignment with providers to create clear and shared goals and ensure that the intended program results are achieved,” said Steve Krupa, CEO of HealthEdge. “In order to be successful, insurers must leverage a modern technology infrastructure that is designed to support the complexities in configuration and administration of these risk-sharing arrangements across all stakeholders.”
Key findings from the study include:
– Health plans are divided on which value-based reimbursement programs are most successful, and respondents were nearly evenly split between patient-centered medical homes, accountable care organizations, bundled payments, and episodes-of-care programs.
– Health plans are struggling with internal (technology, infrastructure, and administrative burdens) and external (member and provider engagement) barriers as they look to implement successful value-based programs.
– Given the data points above, respondents are hedging their bets on significant growth in value-based reimbursement over the next two years.
– For payers, designing and launching any new program can be challenging; the need for provider alignment, complex contracting arrangements and strong member engagement only adds to the complicated nature of VBR.
– Health insurers are concerned about upsetting the status quo on existing margins and must decide on the risk/ reward of taking on the challenge.
– Competitive and market pressures for entering into more VBR arrangements means that they must figure out a way forward. This requires a total commitment by the health insurer’s senior management team and the ability to share data so that providers know how they are doing, and the health insurer can accurately measure the success of shared goals.
Lessons Learned
In order for VBR to work as it should, the respondents agree trust is key. For payers to gain provider trust, they first need to build strong relationships with them through win/ win agreements, and then provide actionable data. But getting the data right can be a daunting task for any payer. It’s not just about claims, it’s about putting information into a digestible format and providing it in realtime to all stakeholders in the continuum of care. Part of building provider, member and employer trust also means being perceived as innovative.
