This is another general article about payments that can effect our specialty.
Providers and payers still must work on forging high-functioning partnerships
On the face of it, the industry is making great strides toward adopting value-oriented payment models, but the question of whether or not the industry is also reducing costs and improving care quality remains unanswered.
Forty percent of all commercial in-network payments are now value-oriented, designed for performance or waste reduction, according to estimates released by the nonprofit research group Catalyst for Payment Reform.
The other 60 percent of commercial health insurance reimbursement remains mostly in fee-for-service, with some payments using bundling or capitation without quality incentives.
But the 40 percent in alternative reimbursement represents a big increase.
Last year, only about 10 percent of commercial payments were in value-oriented models, according to Catalyst for Payment Reform, whose estimates are based on voluntary disclosures from health plans with 65 percent of the nation’s commercially-insured lives.
According to the group’s research, 38 percent of all hospital payment contracts this year are value-based, along with 24 percent of outpatient primary care contracts and 10 percent of all outpatient specialist contracts.
All of which is encouraging, but not necessarily enough.
“Value-oriented payment really only matters if we’re succeeding – if we’re reducing costs and improving quality,” said Andrea Caballero, Catalyst for Payment Reform’s program director during a webcast discussing the results of its annual scorecards for payment reform. “And for many of the methods that we measured, we really don’t have the evidence yet whether they are working. So evaluation of these methods will be our next big challenge.”
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