The state of value-based payments: 5 things to know from 117 financial executives

The Healthcare Financial Management Association asked 117 senior financial executives how hospitals, physicians and payers are feeling about using value-based payment models.

HFMA randomly selected survey respondents from its members holding financial executive positions in hospitals and health systems. The survey, sponsored by Humana, was conducted in September 2017.

Here are five things to know from the survey.

1. Commercial payers using value-based payment models rose from 12 percent to 24 percent since 2015.

"This pace of change is probably somewhat slower than was anticipated in 2015, when commercial payers using value-based mechanisms were projected to be 50 percent in 2018," according to the report.

2. The percentage of overall payments tied to value-based models across various payers is as follows, according to the executives:

  • Traditional commercial (most under-65 plans): 24 percent
  • Negotiated government (Advantage and managed plans): 26 percent
  • Medicaid (not managed plans): 14 percent
  • Medicare (not Advantage plans): 21 percent

3. Of respondents getting some risk-based payments from commercial insurers, more than 80 percent receive those payments through plans with only upside risk or a combination of plans with upside and downside risk.

4. Nearly three-fourths of executives (74 percent) said their organizations saw positive financial results from value-based programs. Only about half of executives (51 percent) said the same in 2015. About a fourth of executives (26 percent) reported unfavorable financial results under value-based payment models.

5. More than 70 percent of respondents anticipate an "extremely important need" for interoperability capabilities to access data. Fifty percent of survey respondents indicated a need for external interoperability.  

More articles on payer issues:
Why Walgreens now appears less likely to acquire Humana or WellCare
Aetna: Former medical director misrepresented our denial process
BCBS of Minnesota CEO to step down: 3 things to know

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