Change hurts, even when it’s change for the good. And that’s what the industry is feeling with value-based payments. Alternative payment models continue to expand, but many of the early pain points still hurt. Left unresolved, issues with data requirements and related administrative management might well overshadow the value and intent of these programs. New kinds of information are being required by health plans for reimbursement under value-based models. Being able to access and deliver that information is critical to protecting revenue and cash flow.

Getting the data right

If you aren’t sending the right information, it’s going to affect your payments. When Availity conducted research into health plan and provider readiness with value-based models, one of the concerns was how difficult it would be for hospitals and practices to manage a growing number of value-based models—all with different metrics to track and report on—while continuing to operate their fee-for-service arrangements. The implication was (and still is) a significant disruption to provider operations and overall performance.

A recent study sponsored by the American Medical Association and conducted by the Rand Corporation confirms that the administrative complexities involved with managing multiple payment models has increased the burden on physician practices. The study highlighted the issue, stating “the multiplicity of pay-for-performance and other incentive programs has created a heavy administrative burden for some physician practices.”

Multiple factors are at play here, and the market offers a variety of solutions. You not only need to be able to track and manage performance measures, but you also need to be able to share that information with your health plan partners so you can get paid. We know that’s easier said than done.


While it will take time for best practices to emerge, there are steps hospitals and physicians can take to ease the burden of managing multiple payment models.

1. Collaborate with your partners.
Health plans and providers need to engage each other. Learn what information is needed to support value-based payment models, and determine the extent of each other’s information-sharing capabilities. Assess how new information exchange needs will affect your current workflow processes. Value-based programs must co-exist with fee-for-service, and this means workflow processes for data access and exchange need to be in harmony. Once you understand what new data is required in the program, determine whether you have easy and efficient access to it.

2. Get answers to these questions:

a.) Can the information I use in my current fee-for-service business help me transition to fee-for-value?

b.) For any truly ‘new’ data, where does it reside—with me or my partners? Is it useful for my traditional fee-for-service business?

i. Can it be accessed easily and efficiently, or will I have to implement additional/ manual workflow processes to acquire it?

ii. What kind of additional resources and time will that require?

iii. How will that affect my overall business and operations?

iv.Once I have the data, how will I get it to the patients’ health plans?

c.) What about my partners? If they have to implement additional/manual processes, how does that affect the success of the program?

3. Evaluate existing market capabilities.

Once you understand what information you need to support value-based programs, do some research to determine what solutions already exist and evaluate them. Understanding your specific needs will help you filter through offerings that tout value-based solutions, but may not truly meet your requirements.

Also, be sure that your organization is making decisions about value-based care and population health solutions with the revenue cycle in mind – they are inextricably linked and need to be considered holistically. It’s unlikely a single vendor can accommodate all your needs, so ensuring you work with open and collaborative partners is critical to success.

Future outlook

Value-based arrangements are here and the industry commitment to them is strong. The Department of Health and Human Services has pledged substantial growth in fee-for-value arrangements by 2020, and a number of commercial health insurers have made similar commitments via the Healthcare Transformation Task Force.

Availity innovations over the past few years have been driven by the value-based trend, including solutions that enable providers to share admission, transfer, and discharge information in real-time with health plans, as well as medical record extracts and attachments. For more information on how Availity facilitates value-based payment initiatives, please click here.