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Change Healthcare national survey of insurers shows value-based care improving

For the first time, commercial payers rather than government lines of business are leading adoption, a report from Change Healthcare says.

Susan Morse, Senior Editor

On average, value-based care initiatives have reduced unnecessary medical costs by 5.6 percent while improving care quality and patient engagement, according Change Healthcare's third report on the status of the industry's move away from fee-for-service.

Close to a quarter of respondents noted savings in excess of 7.5 percent.

Change released its latest report on Monday, just ahead of America's Health Insurance Plans annual Institute & Expo conference.

The research results will be discussed at 11 a.m. PT, Wednesday, June 20, at the conference session "Value-Based Care Market Research: Inside Successful Programs."

Third in a series, the research follows the company's 2014 and 2016 studies.

Despite the easing or ending of federal mandates, the report said, commercial insurers are investing in value-based innovation, accelerating the decline of pure fee-for-service faster than previously projected levels. Currently nearly two-thirds of payment is based on value.

Pure fee-for-service now accounts for 37.2 percent of reimbursement, a figure expected to go below 26 percent by 2021.

For the first time, commercial lines rather than government lines of business, are leading adoption, advancement, and innovation of value-based care models and strategies, the report said.

Almost 80 percent of payers reported improvements in care quality, while 64 percent said they experienced improvements in provider relationships. Seventy-three percent said patient engagement had improved.

Challenges include innovation agility and engaging providers episode of care models.  

Only 21 percent of payers saying they were capable of rolling out a new episode of care program in three to six months. Over a third of payers said they need up to a year to launch a new program and 13 percent said they need up to 24 months or more,

Payers struggle to engage providers in episode-of-care programs, with 43 to 58 percent reporting it is very or extremely difficult to generate interest among providers to participate, to agree on episode definitions and gain consensus on budgets, risk/gain sharing and performance metrics.

Episode models appear worth the effort, as they deliver savings from 5 to 5.4 percent on average, depending on the episode type. 

Exceptional medical cost savings are motivating 66 percent of payers to invest in administrative staff to support future growth of episode-of-care programs.

Over half of payers said they were not very satisfied with their current value-based analytics, automation, and reporting capabilities, despite the fact that many of these are designed and developed in house.

Change Healthcare is a software and analytics company that helps insurers in these areas.

"Payers are finding the positive impact of value-based care as they scale these models--particularly episodes of care--and that's starting to bend the cost curve in a significant way," said Carolyn Wukitch, senior vice president and general manager, Network and Financial Management, Change Healthcare. 

The study, conducted by ORC International and commissioned by Change Healthcare, included 120 payers across a range of organization sizes, and included Managed Medicare, Managed Medicaid, and commercial plans. 

Respondents were comprised of senior executives at director level and above across medical management, finance, technology, network management, analytics, and strategy, who were familiar with value-based care activities at their organization.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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