business

Insurers have big plans for value-based doctor payments

They expect to move away from fee for service quickly but first must overcome technological barriers.

By — Posted May 27, 2013

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Private health insurers have great ambitions to shed fee-for-service payment systems to physicians in favor of value-based models. For the moment, their plans are being held back only by the amount of data insurers can exchange with doctors.

Twenty percent of health plans said at least half their business was supported by value-based payment models by the end of 2012, according to a survey of 39 insurers by Porter Research on behalf of Availity, a health information network in Jacksonville, Fla. In three years, 45% of plans expect half their business to be supported by value-based payments. In five years, that number is expected to be 59%.

The survey found that 82% of health plans consider the development of new payment models a “major priority” for their organizations. Health insurers generally are making the biggest effort to convert from fee-for-service to value-based payments in their employer group plans, with 75% saying they were doing so. By comparison, 54% said Medicare plans were a priority for this transition, 46% said Medicaid plans were, and 44% named individual plans. Respondents could choose more than one answer.

A way to rein in costs

The findings mirror other studies and discussions that have taken place in the wake of the Affordable Care Act and other reforms. Payers and others in the health industry view value-based payment models as a way to improve care and control costs by rewarding doctors for quality rather than the number of procedures performed or patients seen. Insurers have implemented pay-for-performance plans and joined doctors and hospitals in accountable care organizations to make the conversion from straight fee for service.

One factor health plans said was essential to their move to value-based payments is technology. Availity reported that 90% of health insurers said automating information exchange is “critical” to the success of value-based payment programs.

Less than 50% of insurers, however, said they had real-time automation capabilities between themselves and doctors, and 90% said they use computers and paper for information exchange. The study did not detail whether plans believed the lack of technology was because of problems on their end, or a result of many physicians just beginning to adopt electronic health records under the federal meaningful use program, or a combination of the two.

However, 75% of plans said they will automate information exchange with doctors in the next 12 to 18 months so they can begin to implement or expand value-based payment models.

Back to top


External links

“Health Plan Readiness to Operationalize Value-Based Payment Models,” Availity research study, April (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story