VBC: Trust Low, Need For Data Exchange And Integration High

Providers and health plans agree on value-based care obstacles but little else in new findings from Azara Healthcare and Sage Growth Partners.

Only 57% of providers and 18% of health plans report little to no trust in their healthcare counterparts. These are the findings from the new report Bridging the Health Plan/Provider Gap: Data-Driven Collaboration for a Value-Based Future. The report is from population health and VBC solutions vendor Azara Healthcare, based on a survey of 70 health plan and provider leaders by research by healthcare consultancy Sage Growth Partners.

Providers and plans also agree that strategic data exchange is a top priority and that the leading obstacles to implementing VBC are:

1. health plan and clinical data must be integrated
2. clinical data must be clean and consolidated across EHR and network sources
3. care management and care coordination solutions must be united (Azara Healthcare press release).

Other key stats from the report include:

• 64% of providers agree that health plan data exchange is "very important" to VBC success
• 33% of providers and 25% of plans, however, believe that current data exchange helps them identify care gaps "very well."

The state of VBC

The Azara Healthcare report defines VBC goals and progress as:

• Expansion of healthcare coverage
• Implementation of EHRs
• Transition from FFS payments
• Reductions in healthcare spending

Azara gives the first two goals the “green light,” citing a 92% healthcare coverage (Medical Economics) and 96% hospital EHR adoption rates (HealthIT.gov).

The shift from FFS reimbursement and reduced spending don’t fare as well. Here, Azara notes in its report that VBC uptake “has been slower than the market expected” — despite the 50+ alternative payment models that CMS has tested over the past decade — and has not curbed healthcare spending increases despite a mutual interest by providers and payers to reduce total cost of care.   

Consolidation hasn’t curbed costs — what will?

To reduce spending, the Azara report notes that the health plan and provider strategy has been “to get bigger” through consolidation but that this strategy “does not address the underlying challenges of shifting to value-based care—nor does it necessarily streamline operations as expected.”

If consolidation hasn’t worked, what will? Just as there is lack of trust between providers and plans, there is also lack of agreement on how to accelerate VBC, including their biggest obstacles, who benefits most from VBC, and again, lack of trust.

First, the Azara report notes that “[p]roviders and health plans share different views on their core challenges:

• Providers cite lack of buy-in (64%), care coordination staff (58%) and care management staff (53%) as their top challenges
• Health plans rate lack of provider engagement (71%), member acceptance of narrow networks (47%) and market forces (47%) as their main obstacles
• Lack of care coordination and management staff are where plans and providers are most closely aligned but the gap is still wide.  

Lack of VBC buy-in is followed by perceived lack of benefit, particularly by providers. Only 19% of providers believe they benefit most from VBC versus the 58% who see health plans as the biggest VBC winners. Health plans agree, with 62% believing they benefit the most.

Both parties believe that they benefit more than patients or members. 50% of providers believe their patients benefit most from VBC, while 68% of health plans believe their members do.

For providers, the lack of payoff contributes to lack of trust. “Providers are over

3 times more likely to report little to no trust in health plans (57% of respondents) than health

plans are to report low trust in providers (18% of respondents),” Azara reports.

In addition, both parties cite very little improvement in their trust levels over the past two to three years, with 52% of providers and 47% of plans reporting no change.

Lack of trust but not lack of agreement

“When we looked more closely at the pain points and goals of health plan and provider leaders, one common theme emerged: effective, transparent data exchange and integration,” notes that Avalere report, adding that “because this integration inherently involves both parties, it’s a worthwhile place to begin untangling distrust.”

Some 61% of providers and 47% of health plans cite lack of data integration as their biggest VBC implementation challenge. Plans and providers are matched (47%) in their belief that data infrastructure to support whole-person, longitudinal care is lacking. Interestingly, both stakeholders also cite lack of patient/member engagement as a challenge: 31% by providers, 44% by plans.

As for data exchange, identifying and closing care gaps was seen as the primary benefit. Neither providers nor plans believe that current data exchange with one another helps them with these gaps. The stakeholders differ on other goals that data exchange can solve, with 67% of providers wanting to use data to identify high utilization patients versus the 50% of health plans who are seeking better primary and behavioral health integration.

Both parties are motivated to overcome these challenges, with the Azara report concluding:

“Providers and health plans are at a tipping point where the incremental shift toward VBC is poised to accelerate. More VBC contracts alone are not going to move the dial when it comes to delivering more value for providers, health plans, and patients. Moreover, when it comes to perceiving that value, providers need to feel more trust in health plans (and to some extent, vice versa).”

“If transparency is one of the key principles to building trust, then transparent, effective data exchange is a specific, measurable way for health plans and providers to start collaborating more effectively.”