Voice of the Market Survey: Value-Based Reimbursement

Despite the uncertainty around the Affordable Care Act (ACA) and other healthcare reform efforts, it’s clear that value-based models are here to stay. What isn’t as certain is the inconsistency in adoption rates nationwide and which strategies are working well. Because of this rapidly changing landscape and a lack of a sharp picture of how payers are approaching value-based reimbursement (VBR), HealthEdge chose this critical dynamic to explore in its first “Voice of the Market” survey of 2019.


Reflecting the opinions of 151 health insurance executives and their organizations’ adoption of value-based reimbursement, the survey findings indicate that despite being embraced by the Centers for Medicare and Medicaid Services (CMS), VBR has a long way to go before finding widespread adoption and success amongst traditional health insurers.


Key findings from the study include:

  • Health plans are divided on which value-based reimbursement programs are most successful, and respondents were nearly evenly split between patient-centered medical homes, accountable care organizations, bundled payments and episodes-of-care programs.
  • Health plans are struggling with internal (technology, infrastructure and administrative burdens) and external (member and provider engagement) barriers as they look to implement successful value-based programs.
  • Respondents are hedging their bets on significant growth in VBR over the next two years.

These results do not stand alone in their take of the healthcare industry’s temperature on VBR. According to a survey of healthcare executives, clinical leaders and clinicians conducted by NEJM Catalyst, infrastructure requirements and changing policy are top barriers to speeding the adoption of value-based care for them as well. Among 552 respondents who were allowed to choose two answers, the most popular selections for what is hindering the implementation of value-based reimbursement were infrastructure requirements, including information technology (42 percent), and changing regulation/policy (34 percent). Administrative detail (33 percent), sustainability of savings (28 percent), data integration (20 percent) and patient engagement (18 percent) rounded out the list.


Add to these results findings from Deloitte’s 2018 Survey of Physicians, which adds a layer of insights on physician experience and perspectives on resources, tools, behavior-change levers, and compensation. Though many of the survey respondents said that information on quality, productivity, and cost can help them improve the way they practice, physicians without access to data tend to underplay the likely impact of data on their behavior compared with physicians who currently receive this data. A large proportion of physicians (53–62 percent) receiving cost-related information say that they have reconsidered or changed the way they practice as a result of this information. A far smaller proportion of physicians without access to this data (23–39 percent) expect such information to compel them to change their practice. This suggests that once physicians get access to cost-related data, they will recognize its value.


Bottom line: to find success, health insurers must overcome internal barriers to VBR so they can effectively tackle external changes like provider and member engagement while also dealing with regulatory mandates.

The “Voice of the Market” survey was commissioned by HealthEdge and conducted by Survata, an independent research firm in San Francisco. Survata interviewed 151 health insurance executives online between December 18, 2018 and January 7, 2019.

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