Challenge #2: Implementing value-based reimbursement
Placing second among survey respondents’ biggest challenges is implementing value-based reimbursement, which received 22% of responses. Overall, more than half of survey participants, 56%, either have not yet started value-based payment initiatives or have only started a few initiatives. This does show some progress, as last year nearly 70% of survey respondents said they had not yet started or only had a few initiatives started.
Hafner says one reason organizations struggle in this area is that today’s fee-for-service system is not well aligned to deliver true value-based care, and for most provider and payer participants, most business remains fee-for-service. The country continues to tolerate fee-for-service and annual reimbursement increases. “Until that changes, we can’t really expect payers and providers to make the change,” he says.
Secondly, delivering value-based care requires different infrastructure, work flow, and information than what has been in place historically, all of which require investment. Some examples of this include physicians needing to collaborate, integrating clinical and financial data, and having the capability to evaluate, negotiate, and administer risk-based contracting arrangements. To date, the return on such investments has been elusive.
Thirdly, even after a decision is made to move a business model to value-based pay, data and insights needed are not easy to obtain and often considerable lag time occurs when compiling it.