Journey To Value: The State Of Value Based Reimbursement

Two years ago, Change Healthcare set out to answer the question, “Is value-based reimbursement real?” by commissioning a study on the state of value-based payment. There was much discussion about VBR in healthcare circles, but there hadn’t been, to our knowledge, a national survey to determine how much of the discussion was talk versus action. Our 2014 study definitively answered the question. VBR was real, the pace of change was fast, and fee-for-service was projected to be eclipsed by payment models with measures of value by 2020.

Two years later, we again commissioned ORC International, a leading researcher with 15 offices globally and strong healthcare expertise, to repeat and expand the study to see how far the VBR needle has moved. ORC surveyed 465 payers and hospitals in March. Overall, the fast pace of change in healthcare payment continues unabated since 2014, with payers reporting they are now 58% along the continuum toward full value-based reimbursement, a sharp 10% increase since 2014. Hospitals aren’t far behind at 50% along the value continuum, up 4% in the past two years.

Among all payment models within health plans, 59% will be a mix of capitation, P4P, and episodes in five years, with bundled payment growing fastest. Health plans project bundled payment will grow 6% over five years, edging ahead of capitation and shared risk growth. And while both hospitals and payers project bundled payment will account for 17% of medical payment in five years, only half of payers and just 40% of providers say they’re ready to implement bundles. And only a quarter have the tools in place to automate these complex models.