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Adoption of Value-Based Payment Models by Providers

Considering that many medical practices are still unsure of the financial benefits that might be realized by their participating in value-based payment models, a recent April 2014 research study by Availity Health Information Network (availity.com) still finds that a significant number of providers are participating in such payment models. This is true even with the uncertainty as to the financial risks associated with these new models, questions as to the effectiveness of such models, and the payers’ motives for implementing them.

When used in the Availity research study, Value-Based Payment Models (“VBPMs”) refer to payment arrangements that pay physicians, hospitals, medical groups and other healthcare providers based on measures including quality, efficiency, cost and positive patient experience. VBPMs can come in the form of Accountable Care Organizations, patient- centered medical homes, pay-for-performance, payment for coordination, and/or bundled payment initiatives.

Key findings in the research study were as follows:

• 75% of providers participate in one or more VBPMs.
• 30% of providers believe that VBPMs offer enough reward for the risk.
• 50% believe that VBPMs will positively affect health outcomes and costs.
• 20% of provider revenue currently comes from VBPMs.
• 60% of providers believe that VBPMs will become the dominant model.
• 75% of physician practices and hospitals agree that real-time information will be critical for success.

The Study went on to report that primary care physicians are more likely to participate in pay-for-performance models, patient-entered medical homes and payment for coordination plans, and specialists in bundled payment initiatives and Medicare programs, such as the Medicare Quality Incentive Program. The study also noted that approximately 28% of revenues for primary care practices come from VBPMs versus 20% for specialists and that gap is expected to grow over the next three years.

To access the full survey, go to:
http://www.availity.com/resources/published-research/.

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