More than 40% of US health care executives, clinical leaders, and clinicians think value-based reimbursement will become their primary revenue model at some point, according to survey of NEJM Catalyst Insights Council members.
Out of the 552 respondents, a majority (64%) indicated there will be a growth in value-based reimbursement within their organization in the next five years, with 22% of the respondents reporting that their organisation has already started to implement value-based models, while a further 29% said they would be transitioning from fee-for-service models within three years’ time.
However, despite this forecast, only a quarter reported that their revenues currently come from value-based reimbursement, opposed to three-quarters that come from fee-for-service models.
Reflecting on the survey, authors Feeley and Seth Mohta say that while fee-for-service revenue models are dominant, the results demonstrate a “remarkable change to a reimbursement system that was static for decades.”
In an accompanying commentary, Darshak Sanghavi, MD, Chief Medical Officer and Senior Vice President of Translation, OptumLabs, says that “value-based care has achieved remarkable traction, given that almost no contracts incorporated value even 15 years ago.”
He adds “the principal obstacles [to the implementation of value-based reimbursement] don’t appear to be philosophical resistance from providers and administrators, but operational and regulatory concerns. The challenge, moving forward, is to demonstrate how this vision can be realized – and how leaders and providers can trust the value-based payment approach enough to deliver it.”
The survey highlights the main barriers to implementing value-based reimbursement models as infrastructure requirements, including information technology (indicated by 42% of respondents), and changing regulation/policy (34%), followed by problems related to change management (33%) and concerns about sustainability (28%).
Feeley and Seth Mohta also offer other factors of resistance such as the familiarity with the current fee-for-service systems, as well as more evidence to support the link between value-based reimbursement and an improvement in outcomes and cost control.
This last point is reflected in the survey results, where almost half of respondents (46%) said that value-based contracts significantly improve the quality of care and another 42% say value- based contracts significantly lower the cost of care. 36% of respondents said they were uncertain if value-based payment will ever become the primary model for US healthcare.
Despite these uncertainties, 85% of Insights Council members agree that outcomes, costs, safety indicators, patient experience indicators, and process measures, are ‘important’ measures for value-based care, with 60% of respondents saying outcome measures are ‘extremely important’.
Overall, the survey results reflect a cautious optimism that revenue models of US health care providers will continue to move toward value-based models. While it remains to be seen how quick the transition will be, it is clear that value-based payment models are increasing in dominance and there is a willingness from the sector to move in this redirection.
Sanghavi concludes “the challenge, moving forward, is to demonstrate how this vision can be realized – and how leaders and providers can trust the value-based payment approach enough to deliver it. Now the hard part begins in earnest.”
Read the full survey results here: https://catalyst.nejm.org/transitioning-fee-for-service-value-based-care/
