A team of researchers from the University of Washington has been analyzing seven value-based payment programs with an eye toward how the payment landscape may evolve. They’ve published an article on their findings as well as an overview at Health Affairs (link below), which provides a sampling of how some initiatives are playing out.

An analysis of pilot programs implemented in six states (Maine, Massachusetts, New Hampshire, Oregon, Pennsylvania and Washington) found a mixed bag of successes and failures in terms of “payment reform.” Their report attempts to address reasons for varying success and failure rates. Among those factors that seem to facilitate a movement toward value-based models are:

>> Strong, trusted leadership that effectively knows how to balance competing interests between providers and payers.

>> Well-organized payers, particularly at the state level, which are able to sustain market pressures on providers.

>> Access to databases such as an all-payer claims database (APCD) as well-functioning health information exchanges (HIEs) to enable sharing of data.

Factors that appear to facilitate the maintenance of fee-for-service (FFS) payment structures include the following:

>> Lack of ongoing engagement by major purchasers, such as self-insured employers, union groups and consumer groups.

>> Inability to implement a standardized claims adjudication process, which would otherwise enable accurate comparisons across different treatment plans.

>> Competing priorities among different stakeholders, even within a single insurer, for example, when an insurer’s nationwide priorities conflict with those at the state and local regions.

Other factors influencing these dynamics include the costs involved in changing FFS billing processes and payment transactions; healthcare delivery systems that are unable to assume responsibilities for population health (both financially and clinically); and a lack of interest from patients as well as groups that represent patients. You can learn more at the link below.

Heath Affairs:

Author: Jim Wiederhold

Jim believes his 39 years of experience--particularly his more than 26 years in healthcare--has prepared him well for what he does. His wealth of experience spans key areas, including finance, operations, management, leadership, sales and sales management, corporate, contingency, contractual and retained recruiting, outplacement and transition work and executive coaching.