PROVIDER ATTITUDES TOWARD VALUE-BASED PAYMENTS An Availity research study

WHAT’S INSIDE A little bit about Availity

The health care reimbursement landscape

What we learned:

Current and expected adoption levels Administrative and operational challenges Attitudes toward outcomes and cost savings

FIRST, A QUICK NOTE ON WHY WE DO WHAT WE DO.

— Physician News Digest

The physician billing cycle is one of the most, if not THE MOST COMPLICATED REVENUE CYCLE in American business today.

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PUBLISHED RESEARCH Because you need trusted, timely information to develop strategic plans that advance your business, Availity conducts and publishes research on key issues at the intersection of health care and technology.

NOW THAT WE’RE ACQUAINTED…

THE REIMBURSEMENT LANDSCAPE

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REIMBURSEMENT IS CHANGING

Most providers participate in at least one value-based payment model.

• 360+ Medicare ACOs1

• 207 private ACOs2

• + other VBP programs: patient-centered medical home, pay-for-performance and payment-for-coordination.

Meanwhile, revenue is at risk from other market shifts.

• Patient payments are increasing through high-deductible plan membership growth

• Health insurance exchange business is up.

1 The Brookings Institution web site, Year One Results from Medicare Shared Savings Program: What it Means Going Forward, February 7, 2014 2 Leavitt Partners, Geographic Distribution of ACO Covered Lives, December 2013

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PROVIDER IMPACT

Provider challenges: • Increased operational and

administrative complexities • Managing alongside fee-for-

service models • Workflow integration

Downstream effects: • Operational uncertainty • Inability to accurately forecast

revenue • Sustainable and efficient

growth in value-based payment models may be hindered

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Earlier Availity research revealed what was necessary for value-based models to work 1. Limit or eliminate labor-intensive processes. 2. Automation is key

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WHAT’S THE EXPERIENCE NOW?

Availity wanted to gauge current provider experiences, attitudes and concerns regarding value-based payments.

That required us to understand: • Revenue sources and experience • Adoption and growth trends • Attitudes toward value-based payment models • Challenges and barriers to adoption

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SO WE ASKED HEALTH CARE PROFESSIONALS

Web-based surveys were completed by a representative sample

324 practice-based professionals

• Primary care providers • Specialists

216 facility-based professionals

• Mix of hospital and system sizes

THE RESEARCH

KEY FINDING #1 Provider engagement in value-based payments exceeds growth expectations, increasing the already high pressure on operations and staff.

GROWTH EXCEEDS EXPECTATIONS

75% of providers participate in one or more value-based payment model

25% agree that value-based payment models make it easy to understand, track and project revenue

80% say they need additional staff and time to manage value-based payment models

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KEY FINDING #2 Attitudes toward value-based payment models are mixed, reflecting uncertainties and provider concerns.

UNCERTAINTIES AND CONCERNS

30% of providers believe that value-based payments offer enough reward for the risk 50%

agree that value-based payment models will positively affect health outcomes and cost

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KEY FINDING #3 Despite the uncertainties, and while value-based payments represent only a small percentage of current revenue, providers anticipate strong growth.

20% of provider revenue currently comes from value-based models 60%

believe value-based payments of some type will become the dominant model

SIGNIFICANT GROWTH IS EXPECTED OVER THE NEXT 3 YEARS

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KEY FINDING #4 Sustainable growth requires a focus on—and resolution of— data concerns, staff acceptance issues and operational integration problems.

LOOKING AHEAD

60% of providers believe value-based payments will become the dominant model

75% + of physician practices and hospitals agree that real-time information sharing will be critical for success

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ADDITIONAL HIGHLIGHTS: CHALLENGES AND ATTITUDES

The complexity of administering these plans is likely to be costly. The unpredictability of the revenue stream is likely going to make administering some of these plans not worth the cost. - physician practice

Organizational requirements and staffing for the various educational and oversight perspectives of managing value-based payments is a challenge. - hospital

TOP CHALLENGES TO FUTURE USE

0 0 0 0 0 0 0 0

Data management

Practice not suited

Model structure

Potential decrease in availability of care

Cost

Implementation

Staff acceptance, resistance to change

Standardization of terms and metrics

Decreased reimbursement, increased risk

Data accuracy

Uncontrollable parameters, carecoordination

FacilityProfessional

0 10% 20% 30%

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WE ASKED PROVIDERS IF THEY AGREE THAT VALUE BASED-PAYMENT MODELS…

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0 20 40 60 80

Improve quality of care

Improve patient experience

Improve population health

Will become dominant model

Are best suited for large markets

Are best suited for largepractices/facilities

FacilityProfessional

0 20% 40% 60% 80%

TAKE A DEEPER DIVE INTO THE RESEARCH Download a copy of this study and others at availity.com

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