7 Trends in Value Based Reimbursement

Inside Edge Consulting, Princeton

November 13, 2014

#1 Rapid adoption of VBR. About 90% of payers and 81% of providers are already using
some mix of value-based reimbursement (VBR) combined with fee-for-service (FFS).

#2 Collaborative regions are more aligned with VBR. Collaborative regions, where one or two payers and providers stand out, are more aligned with VBR. Regions with more fragmentation have less VBR.

#3 ACOs drive VBR. Accountable Care Organizations (ACOs) are significantly closer to VBR adoption than non-ACOs.

#4 Pay-for-Performance leads the pack. Of the existing value-based models, payers and providers project that the proportion of their total business (inclusive of commercial and
Medicare) that is aligned with pay-for-performance (P4P) will experience the most growth.

#5 IT systems are not there yet. Currently, 15% of payers and 22% of providers characterize P4P as “very difficult” or “extremely difficult” to implement. They also rated Episode of Care/Bundled Payment and others (e.g., Shared Savings) as very or extremely difficult. The key obstacles to implementing these value- based models, payers and providers agree, are a lack of standards, analytical tools, and the need for better business IT infrastructure and systems that support these models—all while taking action to reduce administrative burdens and costs to remain financially sound.

#6 Technology is the key to successful VBR. Integrating IT systems and giving payers and providers useful tools is key.

#7 Clinical buy-in is vital. The largest proportion of payers and providers pointed to a lack of clinician buy-in and engagement with VBR as the number one challenge to its success (20% of payers and 17% of providers).

Healthcare, Healthcare trends, Payers