KPMG survey finds 50% of health systems receive value-based reimbursement

By Dave Barkholz  | January 23, 2017 | Article is Originally from Modern Healthcare

Half of healthcare systems are getting some or most of their reimbursement as part of value-based payments that put providers at risk for the cost and quality of care, KPMG reports in a new survey.

Based on the response of 86 participants, 36% said they receive some reimbursement from value-based contracts, while 14% said they get most of their reimbursement that way, the survey found.

Another 26% said they are planning to enter value-based payment arrangements in the next one to three years with only 7% of the organizations saying they would not.

The remaining 17% of healthcare organizations said they don’t require value-based payments as they remain rooted in fee-for-service, said KPMG partner Joe Kuehn.

“Various parts of the country are transitioning at a slower pace,” Kuehn said. “The vast majority of health plans and providers, however, are moving this way, particularly after the CMS had set some aggressive targets in January 2015, followed by some of the national health plans, to shift their reimbursement in this direction.”

The KPMG results are mildly more upbeat than the Modern Healthcare Hospital Systems Survey results published in June 2016 that found just 13 hospital systems out of 80 respondents said they derived 10% or more of their net patient revenue in 2015 from risk-based contracts.

Two-thirds of the respondents estimated that risk-based contracts generated 1% to none of their net patient revenue.

Hospitals are either not eager to bear downside risk because they are afraid to, or they cannot find health plans willing to share the data needed to negotiate contracts perceived as fair to both parties, healthcare experts said.

KPMG also found that population-health programs are gaining traction among health systems and insurers.

The survey, which was conducted as part of a December webcast, found that 44% of participants had a population-health platform in place that is being “utilized efficiently and effectively.”

Another 24% are in the process of implementing a population-health program within the next three years. And only 10% said they have no plans to implement a platform to support the program, and another 21% of respondents said their organization doesn’t require such a platform.

Population-health management programs are the foundation of a shift to value-based care from fee-for-service, said Todd Ellis, a KPMG principal who specializes in advising healthcare providers.

The programs are achieved by using data and software to help make sure the patients, including the chronically ill, are getting preventive care, taking their medications, keeping appointments and being matched with other agencies to improve their lifestyles.

The information technology, data and clinical workflows for achieving population-health management provide hospitals and clinicians with the visibility to take on risk in reimbursement, Ellis said.

“It’s crucial to doing value-based care successfully,” he said

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