Value-based payment models expected to reach tipping point by 2018, study finds

90 percent of health plans agree that automating the exchange of ‘new’ information required under value-based payments is critical to success.

Eighty-two percent of health plans responding to a recent survey consider payment reform a ‘major priority.’ Nearly 60 percent forecast that more than half of their business will be supported by value-based payment models in the next five years. And, of those, 60 percent are at least mid-way through implementation, according to a study published May 9 by Availity, a health information network.

The Health Plan Readiness to Operationalize New Payment Models study delves into the progress of the country’s commercial health plans, as they migrate from fee-for-service to value-based models of compensating physicians, according to a news release by Availity. The study highlights the consensus among plans that information sharing with physicians must be automated – primarily in real-time – for these models to achieve success.

“With such a strong focus on payment reform in this country, we felt it was important to study how the health plan community was progressing and what connectivity barriers may be delaying or preventing their ability to transition to value-based models,” said Russ Thomas, Availity CEO. “As a health information network, we are keenly aware of our role in enabling the exchange of information needed [by health plans and physicians] to ensure these models work efficiently.

“This study endeavors to identify the information-oriented problems that need solving so the industry can achieve success as quickly and efficiently as possible,” Thomas said.

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Transitioning to payment models that base compensation on outcomes requires physicians and health plans to exchange new kinds of information – different from what is required under today’s predominant fee-for-service arrangements. Ninety percent of health plans agree that automating the exchange of ‘new’ information required under value-based payments is critical to success, with 85 percent saying the highest value will come from real-time exchange, though less than half have real-time capabilities.

The study further details the lines of business targeted for new payment models, payment model maturity, and expectations for growth over the next 18 months.

“The physician revenue cycle is changing and the data collected in this study gives us guidance on how quickly that may happen,” said Thomas. “WEDI (Workgroup for Electronic Data Interchange) recently announced plans to publish a report highlighting areas of focus for health IT over the next 20 years, and value-based payment models made the top three. We’re seeing the shift begin; we’re excited about the future and the contributions we are making to ensure the health of our customers’ businesses.”