The shift to value-based care is on the list of one of the biggest challenges managed care executives face in their organization, according to a new survey.
HealthScape Advisors and the Health Plan Alliance developed and distributed a standardized on-line survey to obtain background information, gather statistics on value-based payment model participation, and understand perceptions of success. They conducted 30- to 60-minute interviews with health plan executives to gather context on survey questions and evolution of value-based payment models.
There are five main findings from the survey results:
1. The shift to value-based payment is a slow one with most plans not yet making the transition to risk.
2. Scale and health plan market share are critical to drive provider engagement.
3. While provider integration or alignment is not a prerequisite, it does guarantee improved performance in value-based payment models and differences are noted between provider sponsored plans vs. non-provider sponsored plans.
4. Transformation capabilities within care management, data management and analytics are viewed as critical drivers of success.
5. Product alignment and member engagement are missing enablers across the industry.
“It is widely recognized that the fee-for-service model is unsustainable given the rapidly escalating healthcare costs in our country,” says Alexis Levy, director at HealthScape Advisors. “CMS has also signaled its commitment to shift to value-based payment. Given these industry demands, this study provides executives with context and benchmarks on other organizations’ shift to value based payment, along with insights and recommendations to help guide health plans to achieve greater success during their continued evolution to value-based payment models.”
With respect to value-based payment, there is not a “one-size-fits-all” approach says Levy. “Models and execution will vary significantly based on a plan’s capabilities, the competitive market landscape, and level of readiness/sophistication of providers in the market,” she says.
Levy recommends three starting points for execution of value-based payment models:
1. Care transformation and data/analytics are core capabilities for value-based payment success.
“Provider-sponsored health plans may have a structural advantage for these capabilities, which they should leverage to help overcome potential size/marketshare challenges,” Levy says. “Non-provider sponsored plans can seek to create models that replicate these advantages. Critical capabilities include bidirectional information sharing with providers and delineation of roles/responsibilities between the plan and provider.”
2. Improve consumer engagement through enhanced product benefit design and consumer navigation support.
Product/benefit design and member engagement are critical levers but have been underutilized by plans to support value-based payment, says Levy. “For plans with mature care management and analytic functions, this represents the next frontier in capability development,” she says. “For plans that have not yet started, integrating product/benefit design and member engagement represents a way to potentially leapfrog competitors.”
3. Accelerate the roadmap to risk by aligning with government models, such as MACRA.
"The adage, 'timing is everything' may be especially apt given the significant change in provider reimbursement represented by MACRA," Levy says. "Health plans can capitalize on the disruption created by this legislation and can work to align the structure of their value-based payment models with the parameters outlined by MACRA."