Mnet Health News delivers the latest news and information articles for the world of healthcare.

A+ A A-

Senators Cosponsor Legislation to End Surprise Medical Bills; Lower Healthcare Costs

Two U.S. senators recently introduced companion legislation that would help consumers manage health care costs and stop unexpected medical bills. U.S. Sen. Jeanne Shaheen, D-N.H., introduced the Reducing Costs for Out-of-Network Services Act of 2018 in October to “combat escalating out-of-pocket healthcare costs for uninsured patients and for patients in the individual health insurance market who receive out-of-network care,” according to a news release.

Cosponsor U.S. Sen. Maggie Hassan, D-N.H., introduced companion legislation to help end surprise medical bills for consumers as a result of receiving care they didn’t realize was considered out-of-network. “Shaheen’s legislation protects patients who are uninsured or in the individual health insurance market, while Hassan’s legislation protects patients with employer-sponsored health plans,” according to the news release.

“The bills that Senator Hassan and I are introducing would help fix chronic problems in our health care system by lowering costs for patients and increasing access to health services,” Shaheen said.  Shaheen’s bill, would cap the amount that hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage, according to the news release.

The Reducing Costs for Out-of- Network Services Act, it states, would:

Significantly reduce out-of-pocket costs for patients who have individual market health insurance and receive care from out-of-network hospitals and physicians;

Substantially reduce out-of-pocket costs for uninsured patients who could otherwise be charged very high “full charge” prices for hospital and physician services; and 

Reduce premiums for individual market health plans by improving individual market insurers’ ability to hold down negotiated provider payments and costs for in-network care.

Shaheen is also cosponsoring Hassan’s legislation, the No More Surprise Medical Bills Act of 2018 that will help “protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount.”

Hospitals would also be required to notify patients in non-emergency situations if their services are is out-of-network and obtain their consent before providing care.  In November, Hassan highlighted the importance of her legislation during a hearing with the Senate Health, Education, Labor Pensions Committee focused on health care costs.

“Studies have shown that nearly 1 in 5 visits involves care from providers who are out-of-network, and non-emergency situations often result in surprise medical bills as well,” Hassan said.  More information: https://bit.ly/2PfE0yY

 

Read more...

The Current Healthcare Payments Landscape and Future Opportunities

The overarching trend in today’s healthcare payments system is that high deductibles have become the norm and patients now have greater financial responsibility. Out-of-pocket expenses are projected to reach $608 billion in 2019 according to a report by Kalorama Information. Here are more trends defining the current healthcare payments landscape:

Confused Patients

Faced with higher deductibles more than ever before, patients are also struggling to understand their bills. A 2016 survey revealed that 72 percent of patients have received a medical bill that they didn’t understand. In addition, according to new research from NORC at the University of Chicago, 57 percent of US adults say they've received a surprise medical bill, and 82% say hospitals are "very" or "somewhat" responsible for their surprise bills,.

Antiquated Processes

Tasks like coverage verification, sending and receiving bills, and obtaining prior authorization (tasks which can all be automated) are costing healthcare providers $9.5 billion annually according to Business Insider Intelligence. These administrative tasks are also one of the reasons of increasing medical bills. Billions could be saved just by automating the antiquated processes in these areas.

Fortunately, healthcare providers and collection firms are investing in new digital payment solutions to combat these antiquated processes according to the latest survey by BillingTree. 54.5% of respondents plan on adding web payments (patient payment portals) within the next 12 months, and 27% plan to add “text to pay bill” (text payments) for the same period.

Paper Payment Systems

There’s still a lot of work to do in the healthcare payments landscape in terms of moving from paper to digital. In a recent InstaMed survey, 58 percent of providers said paper statements are the primary method for patient collections and a shocking 41 percent have not changed their billing process in more than 5 years. This is confirmed by the fact that 79 percent of patients said they have received a paper medical bill. 

Most interestingly, a study of large data breaches (affecting 500 patients or more) by researchers at the University of Central Florida and at the United States Air Force Joint Base in Charleston, South Carolina, revealed that paper and films were the most frequent location of breached data, occurring in 65 hospitals during the study period. While network servers were the least common location, but network server breaches affected the most patients overall.

Future Opportunities: Optimizing Your Revenue Cycle

A recent TransUnion analysis showed that 30% of self-pay accounts (those patients without health insurance or those that have a patient balance after insurance) will generate more than 80% of the self pay revenue collected by hospitals. This means that hospitals may be leaving millions on the table if their revenue cycle is less than optimal. An optimized revenue cycle ensures that earned revenue becomes paid revenue.

Why is this significant? The number of patients without health insurance increased to more than 12% at the end of 2017. In addition, Patient Balances after Insurance (PBAI) grew from 8% of the total bill responsibility in 2012 to 12.2% in 2017. The uninsured rate also grew from 10.9% in 2016 to 12.2% in 2017.

When healthcare providers focus too much on cost control measures, they are missing the bigger picture. As an example in 2018, cutting costs was the highest priority for 63% of hospital C-suite executives, according to a Premier survey.  But a recent Advisory Board study indicated that the typical 350-bed hospital may be leaving $22 million on the table by focusing on cutting costs over optimizing their revenue cycle.

Inefficiencies in the billing process is a huge problem in the healthcare industry but it also creates a massive market opportunity for new and existing healthcare payment tech players.

Read more...

Medical Debt Declines with Patients’ Age

Credit report data for more than four million Americans examined by researchers for Health Affairs shows medical bills in collections are declining among older consumers, but their medical spending is increasing.

According to the research, “the share of people with at least one medical bill in collections decreased nearly 40 percent from patients age 27 to 64.”  Overall, as of 2016, about 16 percent of consumers’ credit reports showed unpaid medical bills referred to collection agencies, Health Affairs reports.  While aging consumers’ medical bills in collections decline, spending increases.  For example, the mean medical spending for 2011-2015 ranges from $4,000 to $6,000 for consumers ages 70 to 80.

The authors of the Health Affairs study, Michael Batty, an economist at the Federal Reserve Board, Christa Gibbs, economist at the Bureau of Consumer Financial Protection, and Benedic Ippolito, an economist at the American Enterprise Institute, also found that “un-insurance rates tracked closely with total medical debt, with younger adults having both higher dollar amounts of medical debt and a higher likelihood of being uninsured.

However, the number of people who accumulate medical debt by age was less closely tied to insurance coverage rates.”  Read more on the study on the Health Affairs website: https://bit.ly/2o9cFmQ.

Read more...

Emergency Brake

The health care world has many moving parts. As a debt collector, it’s your job to be the health care expert—which means it’s often up to you to explain medical bills and insurance coverage to consumers. 

You’ll hear things like, “My insurance should have paid that!” and “I was told I was covered.” In an emergency situation, medical bills get even more confusing.  The patient might not even have been conscious at the time of care to consent to the treatment.

The Emergency Medical Treatment and Active Labor Act requires hospitals to evaluate and stabilize patients regardless of their financial situation. These requirements are mandatory and not affected by payment considerations. The hospital still bills the patient, and the patient is responsible for paying that bill.

This is particularly stressful if patients aren’t satisfied with the treatment and find out their health insurance won’t cover it.  Sometimes patients go to the emergency room, change their mind and refuse treatment, but are still charged a facility fee. Facility fees are charges for a hospital’s services and equipment, and they often come as a surprise to patients.

Even if patients disagree with these charges, unless they can negotiate a lower amount with the health care provider, they are responsible for paying the bill.  Sometimes patients aren’t familiar with their copays. Depending on the insurance plan, copays can vary depending on the type of service used; for instance, payments often differ when you have a preventative medical exam in your doctor’s office versus going to the emergency room after you tumble off a ladder.

Many emergency room doctors–and even ambulance services–are private contractors who might not be covered by a patient’s insurance plan. When a patient receives care from an out-of-network physician, even if it’s at an in-network facility, the patient may be charged for the out-of-network fees.

When patients apply for financial assistance through the hospital, they may believe their bills will be taken care of completely. However, the hospital’s financial assistance policy only covers the hospital’s bill—not those of the emergency room physician, the radiologist, the anesthesiologist or other providers that gave medically necessary care in the hospital. 

Hospitals must list which providers delivering emergency or medically necessary care are covered by financial assistance and which are not.  Here are some helpful questions you can ask the patient:

“What does your explanation of benefits tell you is owed?”

“Why do you feel you are not responsible? Tell me what happened.”

Many consumers feel by carrying insurance, they’ve fulfilled their financial obligation to the medical provider.  But insurance doesn’t relieve patient responsibility. The terms of a patient’s insurance policy will differ between insurance companies. The bottom line: the patient is responsible to pay for services not covered by insurance.

 

Read more...

News & Notes

CMS Finalizes Rule Including Price Transparency Initiatives

CMS Finalizes Rule Including Price Transparency Initiatives

The Centers for Medicare and Medicaid Services is advancing a rule designed to improve access to hospital price information, give patients greater access to their health information and allow clinicians to spend more time with their patients. One component of the rule focused on value-based care and reducing administrative workloads at hospitals requires health care providers to publish costs and policies for price transparency online.  https://go.cms.gov/2nAL2mp 

Study: Why Do Consumers Use Out of Network Providers? 

Nearly 18 percent of inpatient admissions for consumers with health insurance coverage from their employer are with out of network providers, which may increase their costs. Why do consumers have care from out of network providers? The Kaiser Family Foundation analyzed employer plans to find out. One reason is consumer preference; however, in some cases they may not have a choice in their care provider, such as treatment in the emergency room. https://kaiserf.am/2BJy2of 

 

Read more...

3 Growing Trends in Outpatient Care and How They Affect ASC’s

3 Growing Trends in Outpatient Care and How They Affect ASC’s

With rising healthcare costs, patients continue to look for care in new settings according to their preferences and their wallets. According to a report by PwC Health Research Institute (HRI) in April of 2018, the increased willingness of consumers to receive care outside of the hospital or practice is creating disruption in the healthcare industry.

There are two major driving forces for this trend: consumer experience and cost. For example, health retailers like CVS Health and Walmart are focusing on consumer experience to bring patients into the fold and keep them coming back; using reward programs and giving incentives to patients to obtain care at a clinic or offering subscription-type services to keep consumers coming back on a regular basis. 

Consumers and employers all want care to be low cost and high quality. In the same HRI report, eighty-five percent of consumers surveyed would want to take advantage of options that would allow them to finance the costs of large medical expenses.

With that as backdrop, here are 3 trends that will shape ASC’s today and in the future: 

1. More hospitals are investing in ASC’s

As patients seek more convenient and affordable care, hospital systems are increasingly investing in ambulatory surgery centers (ASCs). HCA Healthcare intends to spend $3 billion on new outpatient clinics. Tenet Healthcare is also expected to put down over $1.9 billion in outpatient investments. 

With healthcare’s transition to value-based care, investing in ASC’s makes a lot of sense for hospitals. With advancements in technology (smaller incisions, anesthesia, and pain management), ASC’s have provided better outpatient capabilities; which are better for patients due to lower-cost and higher-quality care. 

It’s a trend that hospitals can’t ignore as technology continues to open doors for more things to be done on an outpatient basis.

2. Value-based care incentives favor outpatient settings

Today’s reimbursement landscape rewards value and penalizes poor outcomes and readmissions. Health plans and government program payment policies support providing services in lower-cost care settings which includes outpatient facilities. 

In a study of Medicare claims data between 2012 and 2015 conducted by Deloitte Center for Health Solutions, hospitals that derive a large part of their revenue from quality and value contracts had 21 percent more Medicare outpatient visits and 13 percent higher outpatient revenue compared with hospitals that did not report revenue from such contracts. 

Outpatient surgery has been known to be safe and effective, achieving similar or better outcomes as inpatient procedures. With outpatient surgery, patients spend less time in a medical facility, recover faster and incur less pain. 

3. Outpatient cost savings is on the rise

With increasing number of patients in high deductible health plans with large out-of-pocket expenses, outpatient facilities are becoming the more logical choice for many cost-conscious patients.

In 2014, Blue Cross Blue Shield reported that outpatient total per-procedure savings ranged from $4,505 for hysterectomy to $17,530 for angioplasty. In 2016, Orthopedic Reviews also estimated an average cost savings of 17.6 percent to 57.6 percent for outpatient orthopedic procedures compared to inpatient. 

More savings could be gained if a greater number of procedures were to be performed in outpatient surgery centers. Only 48 percent of all surgical procedures approved to be performed in an ASC are performed there. If the other 52 percent of approved procedures were performed at ASC’s, an additional $41 billion could be saved annually.

Moving forward, ASC’s that leverage these trends would be better positioned for growth and increased bottom line amidst a changing healthcare landscape. 

Read more...

Are Health Care Costs Affordable to Most Americans?

Old Man's Hospital Bill Gives Him A Heart Attack

Many Americans are struggling to cope with the rising cost of health care.  Recent findings by The Commonwealth Fund show that Americans’ confidence in their ability to afford their health care continues to deteriorate as the cost of health care escalates.

This year, 62 percent of adults told The Commonwealth Fund they were confident they could afford their health care if they became ill or injured, down from 70 percent in 2015. Nearly one in four Americans said health care had become harder to afford.

“Uninsured adults are the least confident in their ability to pay medical bills,” the report found. “But the risk of high out-of-pocket health care costs doesn’t end when someone enrolls in a health plan. The proliferation and growth of high-deductible health plans in both the individual and employer insurance markets is leaving people with unaffordable health care costs.”

The group with the most confidence about their health insurance and the ability to pay for an unexpected medical bill are people with employment-based health plans; the least confident group included those enrolled in Medicare and people with preexisting medical conditions.

Unexpected medical bills can take a toll on both uninsured and insured Americans. The percentage of consumers not paying their hospital bills in full has increased in recent years, according to an analysis from TransUnion Healthcare.  Since last year, approximately 68 percent of consumers with medical bills of $500 or less did not pay the total balance, an increase from 53 percent of consumers in 2015 and 49 percent in 2014.

“There are many reasons why more patients are struggling to make their health care payments in full, the most prominent of which are higher deductibles and the increase in patient responsibility from 10 percent to 30 percent over the last few years,” said Jonathan Wiik, principal for health care revenue cycle management at TransUnion.

TransUnion health care also projects these challenges could continue in the future, speculating that the percentage of consumers not paying their total hospital bills will increase to 95 percent by 2020.  “With millions of dollars in unpaid medical debt, hospitals have begun implementing new processes to prevent revenue leakage while also providing a better patient experience,” said John Yount, vice president for health care products.

More information: https://bit.ly/2MxTxxy

 

Read more...

Data Breach Risks Continue in the Health Care Industry

Data breaches in health care are becoming “routine” with millions of patient records affected in the second quarter this year, according to the quarterly Breach Barometer report from Protenus, a data analytics firm specializing in patient privacy.   

From April to June 2018, there were 143 data breach incidents reported to the U.S. Department of Health and Human Services (HHS) or the media. Details provided for 116 of the 143 incidents show they impacted more than 3.1 million patient records, according to the Protenus report.

This is almost triple the patient records impacted in the first quarter (1.13 million.)  Protenus also finds that 29.71 percent of privacy violations resulting in a data breach were repeat offenses.  “On average, if an individual health care employee breaches patient privacy once, there is a greater than 30 percent chance that they will do so again in three months’ time, and a greater than 66 percent chance they will do so again in a year’s time. 

In other words, even minor privacy violations that are not promptly detected and mitigated have the potential to compound risk over time,” according to the report.  Investigators also have a difficult time keeping up with the volume of “insider threats” when it comes to patient data.  In fact, due to the volume of electronic access to health care data at hospitals and other providers on a daily basis, one investigator monitors an average of nearly 4,000 employees.

The average number of employees with privacy violations increased from 5.08 per 1,000 in the first quarter to 9.21 in the second quarter.  Whether inadvertent or intentional, these internal violations are a big risk to patients’ privacy. And, employees in the health care industry are often looking for information on people they know when they commit a violation.

Approximately 71 percent of insider related breaches in the second quarter included employees accessing records on their family members, according to the Protenus report.  Outside of internal risks, hacking continues to lead to data breaches.  Hacking incidents nearly doubled in the second quarter with 52 reported between June and April.

Health care providers and their business associates, including third-party debt collectors, need to know the privacy rules and take care when accessing patient data, whether medical or financial, to avoid violation of the Health Insurance Portability and Accountability Act (HIPAA.)  Twenty-six incidents reported in the second quarter involved business associates or third-party vendors working with health care providers, affecting nearly 800,000 patient records, Protenus reports.

As data security risks in health care increase, consumers are increasingly anxious about their privacy as well. A recent survey shows almost half of U.S. adults participating are “extremely or very concerned about their health care data security, such as diagnoses, health history and test results,” according to healthsecurity.com.

So, what can providers and their business associates do to get ahead of data security risks and protect their systems, patients and consumers?  Protenus reports best practices are critical for organizations that allow an audit of every employee’s access to patient data. “Full visibility into how their data [are] being accessed and used will help organizations secure patient trust while preventing data breaches from having costly consequences for their organization.”

Read the complete Breach Barometer report from Protenus here: https://bit.ly/2OYOmmW. See Data Watch for a graph from this report.

Read more...

State Health Care Mandates Would Lower Uninsured Rate 

Millions of U.S. consumers would gain access to health insurance while their premium expenses would decline if all states implemented their own health care mandates, according to a study from The Commonwealth Fund and Urban Institute. Massachusetts and New Jersey have mandates and, if every state followed their lead, nearly four million consumers would have health insurance and premium costs would decline by an average of almost 12 percent, according to a news release from The Commonwealth Fund. 

“These mandates would replace the Affordable Care Act’s penalty for not having health insurance, a fee that Congress eliminated, effective 2019,” it states. Currently, the Affordable Care Act requires most Americans to have an insurance plan or face a financial penalty in an effort to “stabilize insurance markets by encouraging healthy people to purchase and stay enrolled in a health plan,” The Commonwealth Fund reports.  

The Congressional Budget Office expects premiums will rise and more consumers will lose their health insurance when the penalty is eliminated in January 2019. However, according to The Commonwealth Fund and Urban Institute Study, if states take the reins and create their own mandates:  

Millions more consumers would have health insurance. In fact, enacting state individual mandates across the country in 2019, when the federal penalties are lifted, would lower the number of uninsured by 3.9 million—or 11.4 percent.  

If all states enacted their own mandate, health care premiums would decline an average of 11.8 percent. The impact on premium rates would differ across states, for example, premiums would decline by more than 20 percent and Colorado, the District of Columbia, Kentucky, Nevada, North Dakota, Washington, and West Virginia would see declines of more than 15 percent.  

The study also shows uncompensated care costs for health care providers would significantly decline. “When patients are uninsured and can’t pay their medical bills, state and federal governments, as well as physicians, hospitals and community health centers, absorb the costs of this uncompensated care,” according to the news release. “As more people gain coverage mandates, demand for uncompensated care would fall by $11.4 billion nationally.  

States can also enact comparable mandate penalties to those at the federal level to mitigate any negative effects of eliminating the penalties under the Affordable Care Act. The study’s authors, Linda Blumberg, Matthew Buettgens and John Holahan from the Urban Institute note that there are significant challenges to getting state-level mandates off the ground.  

“Some states, for example, do not have state income taxes, and new financial structures would have to be developed to collect individual mandate penalties,” they report. “Other state political environments are not conducive to enacting individual mandate legislation, even in states where governors and state policymakers generally support the [Affordable Care Act.]”  

More information: More information: https://bit.ly/2mKefe5

Read more...

Health Care Merger and Acquisition Activity Builds Momentum 

Merger and acquisition activity in the health care sector remains strong this year, particularly for not-for-profit hospitals and health systems, according to an analysis by Kaufman Hall. The number of total transactions reached 50 in the first half of this year. In the second quarter alone, 16 of 21 transactions occurred among not-for-profit hospitals and health systems compared to five transactions among for-profit health care providers, according to the analysis (https://bit.ly/2LDRvKV).  

“When combined with first quarter results, more than 76 percent of deals announced in the first half of 2018 involve not-for-profit acquirers, while less than 24 percent involve for-profit acquirers.” “Not-for-profit hospital and health system leaders nationwide are moving aggressively to broaden their organizations’ base and expand their presence, extending capabilities across larger geographies in order to address continued uncertainty in the industry,” Anu Singh, managing director at Kaufman Hall, said in a news release.  

Revenue cycle management vendors for the health care industry should take note of these trends, according to Corporate Advisory Solutions (CAS), which recently published its second quarter report on merger and acquisition activity (https://bit.ly/2mMr1ZO

“This consolidation is positive for patients, increasing the quality of care to a larger population, but vendors will need to be larger and offer a wide breadth of service offerings to remain competitive,” according to the report. Overall, CAS reports the revenue cycle management (RCM) services sector bounced back to a “normal” volume of mergers and acquisitions after a quiet first quarter. There were five deals totaling a combined enterprise value of $987 million in the second quarter.  

“The RCM industry continues to experience robust growth, which is expected to persist moving forward,” CAS reports. Hospital merger and acquisition activity also continues at a fast pace which, according to data from the Healthcare Financial Management Association, included 25 transactions in the first half of this year, CAS reports. The industry is benefiting from growing health care expenditures which, CAS and the Altarum Institute report, are surpassing growth in the GDP.  

Year-over-year spending increased from 4.5 percent in December 2017 to 4.9 percent in February this year, according to the Altarum Institute. “Within the industry, a push from local governments and advocacy groups for increased price transparency may positively re-shape how consumers make decisions about their health care [expenditures.] A less opaque structure will surely cause prices to drop across the board, strongly benefiting individuals,” CAS reports.  

Finally, advances in telehealth bolster consolidation of health care systems as patients have access to personalized care at home and break away from the traditional care model. Among other trends to watch, according to CAS, providers continue their move toward value-based care payment structures. See Data Watch for a graph depicting the CAS findings on RCM mergers and acquisitions in the second quarter.

Read more...

New Propensity to Pay Technologies Can Reduce Payment Defaults from Self-pay

With revenue coming from self-pay increasingly becoming a large portion of the total revenue for healthcare providers, there’s an even greater need for innovative ways to approach the patient collection process. 

According to the National Association of Healthcare Access Management (NAHAM), self-pay is the third largest payer just behind Medicare and Medicaid. Patients now represent about 30 percent of healthcare revenue. 

Self-pay comes at a high price, especially for facilities looking to clamp down on cost and increase revenue. The cost of collection for self-pay is estimated to be three times that of commercial insurance. Moreover, a significant portion of self-pay balances go uncollected by providers and are eventually treated as bad debt.

Since this problem is connected to the growing financial responsibility of patients (many are unable to offset their medical bills without getting credit), it cannot be avoided. Surgery centers will still have to extend credit facilities to patients unable to settle their medical bills at the point of service.  

However, leveraging new technology has helped minimize the risk of default from patients while also simplifying the collection process for both patients and providers.

Recently, behavioral based propensity-to-pay models have been developed to overcome the limitation of accurately predicting the medical indebtedness of patients. The previous practice was to rely on credit scores to predict the probability of default by patients. Credit scores are however not well suited for this task as they focus more broadly on consumer debt.

This new technology relies on data from multiple sources to accurately predict patient’s likelihood of default. Based on their credit ranking, patients are then offered payment plans tailored to suit their ability to pay. 

Providers therefore have greater assurance of a lesser risk of default on the credit advanced to patients. This in turn results in win-win situation for both parties as their interests are aligned.

By being able to ascertain a patient’s ability to pay before surgery is conducted, an ASC can prevent default by engaging patients on the available payment options. Moreover, the time and effort spent unproductively on tracking collections from patients who are unlikely to pay will be significantly eliminated.

A facility can therefore re-prioritize by channeling more resources to patients with a higher probability of repaying their debts. This should in turn increase the facility’s revenue level while also improving their patient satisfaction ratings.

The increase in patient responsibility for medical expenses is changing the way self-pay is being approached by ambulatory surgery centers. At the core of this shift are innovative technology solutions that improve the collection process through computer-based algorithms.

Needless to say, centers will still have to engage with patients on a personal level to get information that software codes just cannot reveal.

Read more...

Care Quality: Is Value-Based Care Working?

Value-based care, the model that bases payments on quality of care, is starting to reduce medical costs and improve patient services, according to a recent survey from Change Healthcare conducted by ORC International.  In fact, the results show value-based care is accomplishing the “triple aim” sought after in the industry, meaning providing better care for consumers, improving population health management plans and lowering health care expenses.

According to “Finding the Value: The State of Value-Based Care in 2018,” the model is reducing unnecessary medical costs 5.6 percent on average while improving care and patient engagement.  Nearly 25 percent of respondents said their savings exceed 7.5 percent.  

“Despite easing or ending of federal mandates, commercial lines of business are investing in value-based innovation, accelerating the decline of pure fee-for service faster than previously projected levels. Indeed, today nearly two-thirds of payments are now based on value,” according to a news release on the survey from Change Healthcare (https://bit.ly/2KcCGyS).

The survey includes 120 payers such as Managed Medicare and Managed Medicaid across multiple regions and organization sizes.  “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,” Carolyn Wukitch, senior vice president and general manager, Network and Financial Management, Change Healthcare, said in the news release. 

“However, the demand to innovate at the pace of change is challenging payers. They lack satisfactory analytics and automation to better engage providers, operationalize their models and assess effectiveness overall.”  Additional findings from the survey include:

Nearly 80 percent of payers say they’ve experienced improvements in care quality, while 64 percent report improvements in provider relationships and 73 percent report better patient engagement.

The fee-for-service model is fading at a faster rate than predicted in previous studies, now representing just 37.2 percent of reimbursement, and projected to drop below 26 percent by 2021.

More than half of payers surveyed, however, “are 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.”

Visit 2018VBCstudy.com to access the complete research report, Finding the Value: The State of Value-Based Reimbursement in 2018. Examples of value-based care models for health care providers are available from the Centers for Medicare and Medicaid Services (http://go.cms.gov/1jxyhoF.)

 

Read more...
Subscribe to this RSS feed