AHIP speakers weigh in on shift to value-based reimbursement


Payers are being told they need to alter the way they reimburse providers and healthcare providers are being told they need to change the way they deliver their services. One way to help bridge the divide is for payers to develop effective strategies and programs to deliver value-based reimbursement programs.

On June 21 at AHIP Institute 2012 in Salt Lake City, attendees heard firsthand about the second half of that summary. In "Driving Value: Practical Advice for Successful Value-Based Reimbursement Strategies," Jim Evans, vice president of payment management and analytics for McKesson Health Solutions, and Doug Emery, program implementation leader for the Healthcare Incentives Improvement Institute, shared their views of how payers can best make their way to the new world of value-based reimbursement.

According to Nicole Nye, McKesson's assistant vice president of product marketing, there's "a lot of buzz about value-based reimbursement, but it's going to take a lot of change, a lot of testing of new reimbursement and new care delivery models."

She noted that "the whole industry is entrenched in fee-for-service, and there are things that need to be fixed today in order to allow new models to work."

As Nye sees it, the "four buckets" to which payers will need to pay attention as they transition to value-based systems include (1) the design of reimbursement models; (2) the ability to analyze provider networks in order to align benefits with reimbursement; (3) the capacity of members to understand the new configurations; and (4) the development of contracts between providers and payers that can be effectively coded into the payment system.

Nye said most of the technologies and processes exist today and are used primarily to reduce administration costs, but payers are also interested in automating even more of what they're doing today.

As for the future, Nye believes the "rate of adoption [of new systems] is going to be much faster than what we've seen in the past. Industry needs to change and it knows it."

She added that the cost increases currently impacting the industry are unsustainable, and pilot projects sponsored by the Centers for Medicare & Medicaid Services have been imitated in short order by commercial health plans.

And, yes, she concluded, healthcare delivery model changes and reimbursement model changes will indeed go hand in hand.