For several years now, the healthcare industry has been slowly but surely inching toward the tipping point of value-based care.
While the Health Care Payment Learning & Action Network (HCPLAN) states that just 39.3% of all payments had no link to quality or performance in 2020, the organization also found that only 17.9% of reimbursements flowed through the most sophisticated two-sided risk models built on population-based payment structures. That means approximately 40% of payments are still sitting somewhere in the gap between traditional fee-for-service and advanced levels of risk.
To date, health plans, regulators, and forward-thinking providers have done a good job of using payment reform to lay the groundwork for controlling costs and improving outcomes. But the next challenge for health plans will be shifting this middle bucket of largely upside-only reimbursements into more robust and equitable two-sided arrangements.
With the Centers for Medicare and Medicaid Services (CMS) setting the goal of having all Part A and Part B Medicare beneficiaries and the vast majority of Medicaid beneficiaries in some sort of value-based model by 2030, this movement has to start accelerating sooner rather than later.
To meet these targets, health plans need to offer their provider partners the right tools and incentives to make risk sharing less intimidating. With support in the form of personalized patient support and education, as well as smart home monitoring equipment and wearables, providers and health plans can effectively collaborate to control costs, improve experiences, and help members facing debilitating and costly chronic diseases better manage their own care.