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Plans, providers must collaborate for value-based payment models to succeed


Value-based payment models require collaborative efforts among stakeholders


Value-based payment success requires collaboration among multiple healthcare stakeholders, with providers and health plans at the core, according to a new study.

Managing value-based payment models alongside existing fee-for-service models, and across numerous health plans, is creating issues ranging from accurate revenue forecasting to workflow integration challenges, according to "Provider Attitudes Toward Value-Based Payment Models," a study by Availity.

ThThe study provides results relevant to current provider attitudes and concerns regarding value-based payment models. For example, while 75% of providers currently participate in at least one value-based payment model, and more than 60% expect them to become the dominant payment model, fewer than 30% believe they offer a good level of reward for the risk. Furthermore, the study offers insight into current and expected adoption levels, administrative challenges, and attitudes regarding outcomes and cost savings.

Other key findings include:

  • Provider engagement in value-based payments is growing fast, and provider staff are having problems integrating them into their workflows. The result is operational inefficiencies that have the risk of driving increased cost into the system.

  • Provider attitudes toward value-based payment models are mixed; while most participate in at least one model and expect them to become the dominant payment model, fewer than half believe they offer good reward for the risk or will have a positive impact on outcomes.

  • Providers revealed the top barriers to value-based payment success: care coordination, data accuracy and staff acceptance.

  • Provider revealed the top gaps with value-based payment models: data accuracy, data management and implementation assistance.

“The findings in this study provide insight and information managed care and other executives need to improve their collaboration under value-based payment models,” says Russ Thomas, Availity CEO. “The barriers and gaps, in particular, highlight opportunities for leaders to focus their operational improvement efforts and achieve the most value. One of the primary goals of the study was to provide transparency into the issues affecting value-based payment success, and to help foster a healthy dialogue among providers and health plans that would result in early improvements benefitting everyone affected by these models.

The take away is two-fold, according to Thomas:

  • Collaborate: Providers and health plans must work together for value-based payment models to be successful; and

  • Implement technology solutions capable of supporting new data demands: “As providers and health plans collaborate, they also need to evaluate the technology solutions available to support the operational processes and new kinds of information being demanded by new payment models. And the solutions need to satisfy their collaborative needs-not one over the other,” Thomas says. “Half of the gaps and barriers are related to data, making data access, exchange and consumption between these stakeholders critical to success. Implementing solutions that solve these problems for both parties-while continuing to support existing fee-for-service arrangements-will help ensure providers and health plans are prepared for value-based payment models to scale efficiently.”
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