Metrics and Physician Alignment Top List of Value-Based Competencies

When rating their organizations' ability to deliver value-based care within various areas of healthcare finance, providers generally indicate a strong ability.

Healthcare providers report that they are making solid progress as they develop a variety of financial competencies in support of value-based activities, according to the 2018 HealthLeaders Media Value-Based Readiness Survey.

For example, the top two healthcare finance areas in which respondents say their organization has developed competencies to prepare for value-based care are value-based performance metrics (63%) and aligning employed physicians/providers (63%).

At the other end of the spectrum, survey responses show that developing a provider-sponsored health plan (24%) can be challenging. This is because the skill sets and staff necessary to be successful in this area are typically outside of the provider domain.

Also difficult for providers is aligning independent physicians/providers (28%), as it can be problematic to develop risk-based relationships with physicians outside of their organizations.

When rating their organizations' ability to deliver value-based care within various areas of healthcare finance, respondents generally indicate a strong ability.

For example, 79% say that their level of ability is very strong (25%) or somewhat strong (54%) for developing value-based performance metrics, and 73% say that their level of ability is very strong (25%) or somewhat strong (48%) for aligning employed physicians/providers.

Weakest ratings

Sixty-three percent of respondents indicate that their provider-sponsored health plan is very weak (33%) or somewhat weak (30%), and 58% say that aligning independent physicians/providers is very weak (18%) or somewhat weak (40%).

While aligning independent physicians/providers for value-based care is one of the more difficult areas of healthcare finance, it is also one of the more critical.

It is one thing for a provider to be able to deliver value-based care throughout its network, and quite another to provide it across the full continuum of care that includes outside organizations.

The problem is not necessarily caused by a lack of management control over independent physicians/providers, but conflicting financial models, says Karen Hanlon, CPA, executive vice president, chief financial officer and treasurer at Highmark Health.

Based in Pittsburgh, Highmark Health has a diversified portfolio of businesses, including Highmark Inc., a Blue Cross Blue Shield affiliate, and Allegheny Health Network, a health system that features eight hospitals.

"I think that if you're a system that's in a value-based model and you're working with independents that are not in the same model, it's hard to get alignment of financial interests,” Hanlon says.

"One of the things that we're doing at Highmark Health that is having success is establishing clinically integrated networks. These are comprised of our Allegheny Health Network employed physicians as well as independent physicians that join the reimbursement program between our insurance company and the clinically integrated network, which is a value-based contract," she says.

Hanlon continues, "Those independent physicians have signed on to live in that world and are very aligned to a value-based model. But I think absent the aligned economic interests between you as a health system and the independent physicians, it's going to be hard to operate."