Study reveals provider concerns with value-based payment models

May 20, 2014

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. This is according to a study published today by Availity, one of the nation’s leading health information networks.

The Provider Attitudes Toward Value-Based Payment Models study highlights feedback from more than 500 physician practice and hospital-based professionals nationwide. It summarizes the providers’ real-world experience with these new models, revealing perspectives on the impact they will have to the health care system, and calling out the gaps and barriers hindering success. The study follows the 2013 research Availity conducted to determine the operational readiness of providers and health plans to implement value-based models of care and reimbursement.

“The health care revenue cycle is incredibly complicated and it’s undergoing a transformation,” said Russ Thomas, Availity CEO. “In addition to the challenges presented by rising patient financial responsibility and ongoing pressure to reduce operating costs, payment reform initiatives are driving the shift from fee-for-service to fee-for-value. But unless we equip providers – and health plans – with the right tools and access to the information they need, we risk further complicating an already complex and fragmented system. This study identifies key provider concerns, and the gaps and barriers that need to be addressed for these new models to scale and be successful.”

Managing value-based payment models alongside existing fee-for-service arrangements, and across numerous health plans, is creating issues that range from accurate revenue forecasting to workflow integration challenges. According to one physician practice respondent, “The administrative complexity of administering these plans is likely to be costly. The unpredictability of the revenue stream is likely going to make administering some of these plans not worth the cost.”

More than 80% of respondents cited the need for additional staff and time to manage value-based models that represent less than 20% of their current revenues. The need for meaningful workflow tools and real-time information access to help avoid creating expensive, manual processes was named by more than 75% as a key factor to value-based payment model success.

The study further details the specific gaps and barriers affecting the growth and success of value-based models, along with provider attitudes regarding the impacts on population health, the patient experience, and cost.