Barriers to Value-based Care

By Steve Barrett
Sunday, January 1, 2017

The shift from a volume-based to a value-based reimbursement model can yield significant revenue, as evidenced by the $466 million in savings among Medicare ACOs in 2015. But Healthcare Finance reports that only one-third of the roughly 400 health systems in the Medicare Shared Savings Program earned payments, which the Centers for Medicare & Medicaid Services announced in late 2016.

Moreover, healthcare organizations can face physician resistance or at least wariness as they move to a value-based system. A September Modern Healthcare survey of the leaders of 93 hospitals, physician groups, insurance companies, trade associations and other not-for-profit advocacy groups ranked the reasons those leaders gave for why some physicians have been slow to embrace the transition. They include:

  • Fear of change — 29 percent
  • Fear of lost income — 24 percent
  • Fear of lost autonomy — 22 percent
  • Failure of management or leadership — 18 percent
  • Other — 8 percent

Ambulatory Care Providers Rank Payers

Drawing on data from about 800 ambulatory care providers, market research firm peer60 recently ranked the providers’ favorite and least favorite payers.

BlueCross BlueShield (BCBS) was the favorite of 22 percent of providers. Medicare was second, with 16 percent, followed by UnitedHealthcare (UHC) with 9 percent, Aetna with 6 percent and Cigna with 5 percent. UHC was the least favorite payer for 20 percent, followed by BCBS (11 percent), Humana (10 percent), Aetna (7 percent) and Medicaid (7 percent).

In terms of market share of payer contracts, UHC and BCBS had 9 percent apiece, Medicare and Aetna had 8 percent each, and Cigna had 7 percent.

Medicare had the fastest reimbursements, fewest denied claims and least paperwork, while Medicaid had the best pre-certification, least staff time required and easiest negotiations. Tricare had the best customer service. High levels of required staff time and high rates of denied claims were providers’ most common complaints.

Getting What You Pay for in Health Care?

A survey by Public Agenda found most Americans do not automatically link the quality of a healthcare service with how much it costs. The findings were analyzed in Health Affairs.

Depending on how the question was asked, 58–71 percent of respondents did not associate price with quality. However, 21–24 percent did make that connection, and two in five said physicians who charge less than other providers for a service may not be providing the same quality of care.

Researchers determined that people were more likely to draw a connection between the quality of a service and its cost if they had compared prices among providers.

The findings show caution is warranted when physicians provide pricing information, researcher Kathryn A. Phillips, PhD, Professor of Health Economics and Health Services Research at the University of California, San Francisco, told Physician’s Weekly. Patients may steer clear of less expensive care if they see it as being of lower quality, she added.