Whether you love it or not, the Patient Protection and Affordable Care Act – commonly known as Obamacare – has undeniably imposed new thinking about how health care is delivered and how providers are paid. As a result, in the next few years, the health care industry is expected to migrate from fee-for-service payments to a value-driven system that rewards quality and cost-effective patient care.

These payment models are collectively known as value-based payments, and payers and providers alike are gearing up for value-based payment programs to become increasingly popular. Payers and providers expect their participation in value-based care programs to more than triple in the next three to five years, according to a new series of original research studies from Availity. (Read Provider Readiness to Support Value-Based Payment Models, the companion study to health plan research published earlier this year.)

In our research, both payers and providers admit they’re not prepared for the information exchange demands required to make these models successful. More than 90 percent of respondents from both groups surveyed agree they must automate information exchanges. However, only a small percentage of providers and plans report having those automation capabilities in place – leaving a questionable gap in the current operational readiness of the market.

The shift to value-based payment models has broad support and is expected to grow quickly over the next three years. With providers and payers not prepared, migrating to these models presents a high risk for significant market disruption.

Success of the migration to value-based payment is further complicated by health care reform and the industry transition to ICD-10. Both have broad-reaching impacts on health care providers and information exchange.
The bottom line

Early adopters of value-based programs, while encouraged by outcome improvements, are highlighting concerns related to data access, exchange and lack of automation.

If providers and payers cannot simply and effectively share data (such as the information required to substantiate quality outcomes or to trigger care coordination), program scalability will be severely limited and the costs to continue operations will likely outweigh the benefits.