After predicting they would take on significantly more financial risk, provider executives failed to meet their own outcomes-based payment goals, according to a new survey.
The research, conducted by the consulting firm Numerof & Associates and David Nash, M.D., dean of the Jefferson College of Population Health, found that in 2015 almost 60% of executives predicted they'd be very or entirely prepared to take on risk in 2017. However, only 21% achieved that mark.
Additionally, in 2015, 84% predicted more than 20% of their annual revenue would come from risk-based agreements, but actual 2017 figures found only 30% of providers reached that mark.
Respondents cited the threat of financial losses as a deterrent to moving to risk-based models, like Track 2 and 3 accountable care organizations (ACOs), as well as issues regarding new technology implementation and management changes.
The survey follows other reports indicating the transition toward risk-sharing partnerships has been slower than expected, including an analysis that found the Congressional Budget Office's initial projection for savings from ACOs was off by several billion dollars. Such arrangements have been touted as a way to decrease healthcare spending and improve patient conditions by holding providers responsible for costs and outcomes.
Despite the slow adoption, a few organizations did report a substantial portion of revenue moving to new models, increasing the gap between lagging providers. Also, support for population health remains universally supported with 95% of respondents saying it is the future of healthcare.
That emphasis on population health has solidified over the last several years. When the survey was conducted three years ago, most providers only had a conceptual understanding of what population health consisted of, says Rita Numerof, co-founder and president of Numerof & Associates, and providers soon realized the shift in care would be more difficult than they first imagined.
She added that executives' new projections for 2019 and 2020 are likely to be more realistic due to their recent experience.
The sluggishness of adoption of risk-based arrangements has led to calls for a stronger push by the government to get providers into these models. Department of Health and Human Services officials Alex Azar and Seema Verma have both signaled support for that approach.
"Pushing more risk and creating mandatory reporting is a good thing," Numerof told FierceHealthcare. "Providers are not going to do anything until they are forced to."