And then you have to agree on what
value-based care is in a financial sense.
Does it mean the same thing to both
parties?” According to Walters, some
questions to ask include: Will providers get paid for meeting certain quality measures for certain subsets of
patients? Does it mean meeting targets
that include a medical expense target
as well as some quality measures? And
if you meet the target, do you get a
bonus? Do you share in that bonus?
How much do you share in the bonus?
Which patients are covered?
Perhaps one of the greatest challenges of preparing for value-based
care is simply the sheer number of
permutations that the model offers.
Every organization will have to sort
through the various combinations of
upside and downside risk, bundled
payments, and capitation, and ultimately decide what works best for
them and their patients. H
Jonathan Bees is senior research analyst for
HealthLeaders Media. He may be contacted
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that at least 50% of their patients are
currently in value-based programs, but
in three years’ time, that more than
triples to 64%.
Respondent expectations for
growth in the percentage of patients
in value-based programs is significant: the under 25% share segment is
expected to decline by 51 points, and is
the only segment predicted to fall; the
25%–49% segment increases 5 points; the
50%–74% segment increases 25 points;
and the 75%–100% segment increases
22 points. These are dramatic changes
in share, particularly when you consider they are for a three-year time period.
Similarly, respondent expectations
for net patient revenue growth from
value-based programs is also bullish.
Respondents say that their net patient
revenue percentage is currently 20%
value-based and 80% fee-for-service,
and they say these will go to 50% each
in three years. The results indicate that
value-based models will soon reach
parity with fee-for-service.
At Trinity Health, Walters says that
its targets are even more aggressive. The
current expectation is that 75% of net
patient revenue will be value-based in
2020. She says there are numerous factors for all providers to consider as they
make the value-based journey.
“You need a willing provider group
and you need a willing payer partner.
the highest response for improved
outcomes and lower costs, although
its response is only marginally higher than the other payment models,
both fee-for-service and value-based.
Interestingly, the top three responses for improved outcomes, no cost
reduction are all fee-for-service based:
fee-for-service with upside rewards,
such as performance awards (26%),
fee-for-service with no value-based component (20%), and fee-for-service with
downside risk, such as reimbursement
When asked to rank the possibility of the various models evolving to
become their organizations’ principal value-based payment model,
respondents say that fee-for-service
with upside rewards, such as performance awards (23%) is the top-ranked
payment model, followed closely by
shared risk, such as ACO (20%), and
bundled payment program(s) (19%).
The payment models receiving the lowest responses are partial capitation (4%)
and full capitation (5%), indicating
respondents’ low expectations for these
Value-based model growth. While
the transition to value-based care is in
the early stages of its adoption, the outlook for growth in the share of patients
in value-based programs is robust. For
example, just 17% of respondents say
PLEASE RANK THE TOP THREE PAYMENT MODELS (FIRST, SECOND,
THIRD) BASED ON THE PROSPECTS OF THEM EVOLVING INTO ONE
OF YOUR ORGANIZATION’S PRINCIPAL PAYMENT MODELS FOR
VALUE-BASED CARE. (1ST RANKED)
Fee-for-service with upside rewards,
such as performance awards
Shared risk, such as ACO
Bundled payment program(s)
Fee-for-service with downside risk,
such as reimbursement penalties
Medicare Shared Savings Program
with up-side and downside