Payers

How payers view the transition to value-based care

A new survey of 120 payers found that while health insurers see the positive impact of value-based care initiatives, challenges still remain, particularly regarding innovation and analytics.

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As value-based care continues to be a much-discussed topic, a survey of 120 payers looks closer at the industry’s progress and the challenges it faces in this space.

Titled Finding the Value: The State of Value-Based Care in 2018, the survey was conducted by ORC International and commissioned by Change Healthcare. Commercial, public exchange, Medicare Advantage and Managed Medicaid insurers of various sizes from across the country answered questions in April of this year.

On a positive note, through value-based initiatives, payers saw a reduction in medical costs. On average, respondents reported medical cost savings of 5.6 percent. Thirty-seven percent of payers said their savings reached between 5 and 7.49 percent.

The study also had good news as far as the Triple Aim is concerned. Seventy-seven percent said value-based care strategies greatly or slightly improved care quality, 73 percent said they greatly or slightly improved patient engagement and 64 percent indicated they greatly or slightly improved provider relationships. Eighteen percent reported value-based strategies had a negative impact on their relationships with providers.

Speaking of providers, health insurers appear to have trouble across the board in dealing with certain aspects of collaboration. Fifty-eight percent of payer respondents said it is extremely or very difficult to agree with providers on contracted budgets and risk/gain sharing. Fifty-one percent indicated it’s extremely or very difficult to reach a consensus on episode-of-care performance metrics and reports.

The time needed to implement episode-of-care programs also poses a problem. Twenty-one percent of payers said they need three to six months to put such a program into place. Another 34 said they require six to 12 months, and 21 percent noted they need 12 to 18 months to roll out such an initiative. As the survey notes, this points to a lack of innovation agility within the value-based care realm.

Health insurers aren’t happy with their analytics capabilities, even though they create some of these solutions in-house.

Fifty-nine percent of payers said they internally developed their analytics tools for pinpointing clinical performance variations. But at the same time, 53 percent said they’re moderately, slightly or not satisfied with their analytics that identify clinical variations. Additionally, 78 percent of insurers reported they internally formed their analytics tools for identifying cost performance variations. But 44 percent said they’re moderately, slightly or not satisfied with their tools for spotting cost variations.

On the whole, the survey does indicate payers are recognizing the positive aspects of value-based care programs.

“However, the demand to innovate at the pace of change is challenging payers,” Carolyn Wukitch, Change Healthcare’s senior vice president and general manager of network and financial management, said in a news release. “They lack satisfactory analytics and automation to better engage providers, operationalize their models and assess effectiveness overall.

Photo: Hong Li, Getty Images

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