New research from the Society of Actuaries has identified several factors that will help ensure a provider's successful transition to value-based care.
The report, "Navigating The Transition To Value-Based Care," concluded that the payment models must include:
A reasonable method to determine patient costs
An equitable process for allocating quality incentives among participating healthcare providers
A well-designed provider network aimed at fostering cost savings
The most efficient healthcare delivery system within the specific market
However, the society also noted it was difficult to observe and draw conclusions from many examples of value-based care.
"The authors found that it is neither easy nor transparent to see how these organizations interact or coordinate results, even for those well-versed in U.S. healthcare," the report said. "In addition, methods of reporting results of payment reform studies were not necessarily methodologically rigorous, which made it difficult to reach definitive conclusions on whether specific reported payment reform models were successful."
The U.S. healthcare sector is struggling to make progress with value-based payment initiatives. Many providers have made little progress with their initiatives, and seem to be hesitant to ditch the time-honored fee-for-service model. And while some progress has been made in reducing the levels of "low-value care" that are being delivered, many providers have dropped out of the Pioneer Accountable Care Organization program, noting that they have struggled to meet the performance and financial goals that have been delineated by the Centers for Medicare & Medicaid Services.
To learn more:
- read the report (.pdf)