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Drivers and Barriers to Value-Based Care Adoption
December 2017
Supported by governmental and payer programs that focus on value across the healthcare system, healthcare organizations are increasingly participating in value-based risk contracting. These organizations are evolving from fee-for-service physician-centric hospitals focused on their inpatient care, to organizations focused on clinical integration, population health, or even person-centric organizations with the consumer as central to the organization of care delivery.
This shift has not been without its challenges, such as physician engagement and alignment and data-driven insights to manage risk and clinical outcomes. Truven Health Analytics®, part of the IBM Watson Health™ business, examined healthcare leader survey results to better understand the challenges and steps these leaders are taking to respond to the shift towards value. Download the latest FactFile to learn more about these survey results.
There continues to be uncertainty regarding the outcome and impact of legislative efforts to repeal the Affordable Care Act (ACA). Proposed changes could have a significant impact on uninsured populations—affecting the proportion of uncompensated care provided by the healthcare organizations that serve them.
Download this FactFile to learn more about projected differences across service lines and locality of both uninsured patient care and uninsured ED visits.
The healthcare industry has undergone remarkable changes over five years. Many things have impacted the financial health and stability of hospitals across the United States during this time, including the implementation of the Affordable Care Act (ACA) with the concurrent expansion of Medicaid in some states, the push to reward and penalize based on value, migration of inpatient services to the outpatient setting, and ongoing mergers and acquisitions.
Truven Health Analytics, part of the IBM Watson Health business, has analyzed regional trends in profitability, liquidity, uncompensated care, and collections and reimbursement to study how this period of great change may have impacted financial indicators of hospital performance across the United States. There are striking differences between some regions, potentially indicating the impact of Medicaid expansion, the ACA, and regional patterns of charge structures.
The American Health Policy Institute (AHPI)1 defines high-cost claimants (HCC) as those patients who cost $50,000 per year. In a 2016 study of 26 large employers, AHPI found that HCCs cost an average of $122,382 annually, and that they comprised 31% of total spending. Both payers and providers are concerned about the etiology behind the cost of care for these patients.
Payers are putting pressure on providers to take on greater risk and mitigate cost as they move to value-based care and better outcomes. Payers faced with increasing healthcare costs are looking to consumers to become more engaged from both a financial and care perspective.
