Survey: Payers, providers struggling with disruptions, value-based care

Payers and providers are struggling to navigate new industry disruptions and are still struggling to push forward value-based initiatives, according to a new report.

Change Healthcare partnered with the Healthcare Executive Group to publish the 9th Annual Industry Pulse Survey and found that one-third of all surveyed healthcare executives believe non-healthcare market entrants—think Amazon’s recent partnership with JPMorgan and Berkshire Hathaway to form Haven—could upend current business models. 

In addition, almost 40% of survey respondents said a value-based system is at least 3 to 5 years from coming to fruition, as payers and providers are still looking for a positive reimbursement model. 

"I think moving to value-based relationships with both upside and downside risk is one of the most important aspects of transforming our industry through aligned incentives," David Gallegos, senior vice president of consulting services for Change Healthcare, told FierceHealthcare. "But doing this is hard work."

Many industry players lack needed technology and processes to support the key parts of value-based care—such as a population-based, whole-person approach to care, Gallegos said. 

RELATED: Study: Consumers skeptical of value-based insurance design

First, taking a closer look at the influence of tech companies and retail, 32.2% of those taking the survey said that these external market entrants will disrupt current business models. The second highest disrupter cited in the survey was innovation in healthcare delivery, noted by 13.3% of respondents, followed by refinement of consumer experience, flagged by 11.1%.

Another disrupter was the survey’s focus on social determinants. About 18% of the survey respondents cited coordinating with community programs and resources as the organization’s top priority for integrating in these health programs. Offering social assessment with the health risk assessment, cited by 15.1%, and integrating non-medical data, noted by 13.9%, were second and third on the list. 

Surprisingly, results for these social determinant questions were very similar to 2017, indicating that integration of social determinants may have stalled.

And where do the barriers to care exist in early 2019? According to the survey, more than half of executives (63.7%) cited care coordination as a hurdle to battle in the next 12 months. Other top contenders included transportation (39.1%), food insecurity  (27%), benefits coordination for public assistance (23%), and social isolation (19.4%). Just over 17% of respondents said they would not be addressing non-medical barriers to care at all in the next year. 

For those facing hurdles to integrating non-medical into clinical care programs, lack of payment structures ranked as the No. 1 barrier with close to 50%. Other top challenges included effective metrics, 48.7%, member adoption, 45.5%, data sharing limitations, 42.9%, and adding skill sets to address social determinants of health, 40.7%. 

RELATED: Industry Voices—Six keys to focusing on social determinants with the biggest economic impact

The survey also found that value-based contracts (VBC) are not being adopted as quickly as expected. More than 90% of all survey respondents said that VBC won’t be adopted for between 1 to 5 years. 

But why is the industry stalling on VBC? Respondents cited limitations on data sharing, no agreement on outcome measures and lack of incentives to force payers and providers to work together. 

The respondents said that payers need to work more effectively with providers to facilitate high-value care. Payers should do this through standardized quality and outcomes measures, almost 30%, and developing payer-provider risk management programs, 22.6%. And sharing performance data came up as the third most important step at 13.9%.

It’s also clear from the survey that financial incentives are truly needed if payers and providers are going to share data work together. 

In 2018, priorities of healthcare executives shifted a bit from previous years due in large part to external issues. Of critical importance was once again customer service, data analytics and member retention, but this year privacy and security also made the list. 

And for payers, providers and healthcare executives, government regulation remained the most common challenge for the coming year. 

"There are a lot of lessons that can be learned from other industries. Healthcare consumers want the same thing that consumers of other industries want: value, dependability and hassle-free service," Gallegos added. "We have a very fragmented healthcare system. This makes it difficult for patients to navigate through the various treatment options and payment requirements. Having a more connected healthcare system would significantly improve the patient experience."