Nearly 60% of health systems aim to become 'payviders' in 2022, survey finds

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A new survey finds more and more health systems are exploring value-based risk contracts in Medicare Advantage as payers aim to increase investments in the provider space. (Getty)

Nearly 60% of health systems in a new survey plan to get into risk-based Medicare Advantage payment models next year, part of a growing trend of providers seeking to become “payviders” and have a greater role in risk management.

The details were part of a survey released Monday conducted by the Healthcare Financial Management Association, which represents hospital executives. The survey of more than 100 health system chief financial officers and other executives was conducted between July and August of this year.

It found that health systems are looking to diversify their risk-based payment strategies. For example, 52% of respondents plan to enter into commercial employer-based risk contracts, 49% into Medicare payment models, 36% into managed Medicaid and 33% into direct-to-employer partnerships.

“We’re seeing increased interest from providers to own the premium dollar through risk-based arrangements,” said Richard Bajner, partner at Guidehouse, the firm that analyzed the survey, in a statement. “On the other hand, large payers have been more aggressive in building and even investing directly in primary care assets to gain control over the flow of care and better manage services delivered to members.”

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Fifty percent of respondents pointed to strategic partnerships with payers as their top external challenge.

“Industry disruption has created new opportunities for health systems to rethink the structure of their payer and provider partnerships, reassess their markets for new entrants with a willingness to innovate together and readjust their network strategy to align with where their market is going,” said Travis Sherman, director with Guidehouse, in a statement.

The survey also explored the barriers providers face in a transition to risk.

It found 33% of providers listed data integrity, reporting and the cost of technology as the top internal challenges to taking on increased levels of risk.

“While half of respondents are building these capabilities in-house, 30% are partnering with payers to support risk-based capabilities and 21% are outsourcing services to a third-party organization,” according to a release on the survey.

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The findings come amid increased scrutiny of coding practices in MA.

A series of articles in the journal Health Affairs highlighted what it deems a perverse incentive in the marketplace where plans can get large overpayments from Medicare by increasing diagnosis codes on patients and thereby risk scores that can affect MA payments.

Plans have also employed several tactics to get more diagnosis codes from providers, including buying providers outright and engaging in more value-based care payment contracts that share in risk-based premiums.