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Hospital and health system leaders reveal that movement to risk-based payment models is moving slowly, most claiming that less than 20 percent of their patient population is covered under such arrangements, according to a recent Premier healthcare alliance survey. These healthcare providers remain interested, however, in greater engagement in risk-based payment models ranking Medicare Advantage, employer-sponsored health plans and fee-for-service Medicare as the three priority areas.
Risk-based models include accountable care organizations (ACOs), bundled payments, and other types of alternative payment models (APMs) that hold providers accountable for the cost and quality of care across the continuum. The survey also revealed the fundamental reasons for this slow pace, which largely amounts to needed economic incentives and access to timely and accurate claims data. This points to needed policy changes, as well as action by private organizations.
Across all payer types, most respondents indicate that less than 20 percent of their population was covered in a risk-based arrangement.
Over the next five years, only 5 percent of respondents expect to have more than 80 percent of their population in risk-based arrangements.
Reimbursement inadequacy was ranked the top barrier standing in the way of shifting to risk-based models in the Medicare fee-for-service program.
The survey revealed that providers need more access to timely, accurate and complete claims data as the shift to risk-based models unfolds.
Congress can recognize the upfront investment needed by healthcare providers to move to two-sided risk by:
Providers need greater flexibility to innovate and coordinate care, including:
Congress can also require federal and commercial payers to provide timely access to administrative and claims data to healthcare providers, especially those in value-based care arrangements.
"Strong partnerships between payers and providers are key to moving to risk-based contracts that will transform the way care is delivered and drive better outcomes and value. These partnerships need to be built on access to standardized claims data, shared risk, clarity of roles and responsibilities and transparent business relationships." - Carrie Nelson, MD, Chief Clinical Officer of Advocate Physician Partners
"There is a great deal of uncertainty as we explore moving to risk-based contracts. We call on the Administration to provide more details on the emerging alternative payment models to help inform the best path forward for our system." - Steve Neorr, Senior Vice President and Chief Administrative Officer, Triad HealthCare Network.
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