From Fee for Service to Value-Based Care. Well, There’s a Ways to a Go Yet | Managed Healthcare Executive® State of the Industry Survey

MHE Publication, MHE January 2023, Volume 33, Issue 1

The survey also showed that many believe value-based care is being gamed and that chances that it will be successful are small.

Weaning U.S. healthcare off fee-for-service payment to value-based care arrangements that reward cost-effective care has been talked about for years. But walking that talk has been a halting, sort of effort for a tangled set of reasons, not the least of which is the ingrained, staying power of fee for service

The Managed Healthcare Executive® State of the Industry confirmed that the move toward valued-based has been modest and revealed some jaded views.

Asked to rate their own organization’s shift away from fee for service to value-based care, 12% of the 450 respondents indicated they hadn’t started, 27% indicated beginning and 27% indicated midway. Only 17% rated their organization as being mainly in value-based arrangements.

About one-third (34%) of the respondents indicated agreement with the statement that value-based care arrangements and payment models are “admirable but the chances of success are small.” A large proportion (41%) agree with the statement that they have been “gamed by some organizations to increase profits and revenues.”

There is some optimism, albeit tethered. A large if minority group of the respondents (37%) said the value-based arrangements were on the right track but needed adjustment. Abou the same proportion (39%) said the arrangements don’t provide enough of an incentive to lower healthcare spending.

Accountable care organizations (ACOs) and bundled or episodic payment arrangements have gotten a great deal of attention. But 39% of the respondents to the survey said pay-for-performance incentives were most likely to be successful in improving outcomes and reducing costs this year. Only 20% thought ACOs would and only 18% thought bundled payments would.