Limitations on data sharing are one of the obstacles to value-based contracts, as identified by health plan industry professionals.


March 19—Health plans see a shift to value-based payment on the horizon, according to a new industry survey. It’s a familiar finding.

“Year after year, shared-risk, value-based health care has appeared to be just around the corner,” according to the analysis of a new survey of health plans from Change Healthcare. “However, health care seems to be perpetually stuck at being three to five years away from adopting shared-risk value-based contracts.”

Specifically, in the survey of 185 health plan executives, more than 90 percent said that value-based contracts (VBCs) won’t be dominant for at least one to five years—if ever.

Obstacles to value-based care that health plan professionals identified included:

  • Limitations in data sharing
  • Lack of agreement on outcome measures
  • Lack of incentives for payers and providers to work together

“All of this leaves healthcare leaders feeling unable to tackle the challenges of implementing and managing VBC,” the analysis stated.

Seeking Support for Providers

The survey found mixed results in payer support of providers’ efforts to move to high-value care. Continued obstacles include a lack of standardized data and outcome measures, according to 27.9 percent of respondents. Standardized measures are critical to care coordination, but data formats usually differ between health plans and providers, according to the analysis.

However, health plans identified ways they can promote high-value care, including:

  • Working with providers to develop risk-management programs (cited by 22.6 percent)
  • Sharing performance data (13.9 percent)
  • Co-developing bundled payments around episodes of care (13 percent)
  • Developing application programming interfaces to improve interoperability (10.6 percent)
  • Sharing outcomes data (7.7 percent)

Lack of Exposure for Value Arrangements

One possible issue affecting health plan executives’ perceptions of value-based payment arrangements (VBAs) is a lack of publicity.

A recent survey-based analysis of executives with health plans and biopharmaceutical manufacturers found more than 70 percent of VBAs implemented between 2014 and 2017 were not publicly disclosed.

“This study reveals that the majority of VBAs are not publicly disclosed, which could underestimate their true prevalence and impact,” the authors concluded.

Slow Progress Among Providers

Fee-for-service payments still account for 78 percent of care delivery, according to a recent Lumeris survey of 172 health system executives. Although just 22 percent of care delivery payments were based on value, that share has risen five percentage points over the last year. And healthcare executives who were surveyed anticipated that the percentage will climb to 25 percent over the next year.

In calculating compensation, 81 percent of health systems have structures that include value-based metrics for employees, including physicians, nurses, and C-suite executives.

Looking ahead, 46 percent of responding executives believed their organizations’ movement toward value-based payment is happening quickly or very quickly. That represents a 14-percentage-point increase from responses received a year earlier.

In terms of the types of risk providers are moving toward, 62 percent of health system executives indicated they plan to assume additional risk in the next 12 months. The mechanisms:

  • Accountable care organizations (46 percent)
  • Medicare Advantage (31 percent)
  • Bundled payments (23 percent)


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, March 20, 2019