Health plans invest in value-based models


Health plans investing heavily in value-based models

The number of health plans that expect more than half their business will be under value-based models is expected to triple in the next five years according to a new research report released by health information network Availity.

According to the study, “Health Plan Readiness to Operationalize New Payment Models,” only 20 percent of health plans say value-based payment models support more than half of their business today, but 60 percent of companies responding to the survey anticipate they will support more than half their business within five years.

Of the six valued-based models studied, the patient-centered medical home (PCMH) is the most common model, with 62 percent of health plans reporting they have implemented a PCMH. An additional 19 percent are in the process of implementing one. Accountable care organizations are not far behind – 47 percent of health plans have implemented this payment model and another 40 percent are in the process of rolling one out.

“With such a strong focus on payment reform in this country, we felt it was important to study how the health plan community was progressing and what connectivity barriers may be delaying or preventing their ability to transition to value-based models,” said Russ Thomas, Availity CEO, in a press release explaining the purpose of the survey.

With technology and automation of information exchange touted as vital to the implementation of new payment models, Availity found that 90 percent of the health plans surveyed said their method of sharing information was a hybrid of automated and manual systems. Nearly three quarters (74 percent) of health plans reported they were working to increase their automated methods of information sharing in the next 12 to 18 months.

In all, roughly half of the health plans have real-time reporting capabilities in place though it is unclear what ability the plans have for using those capabilities to exchange new information types. That said, health plans understand how vital it is to have effective methods of sharing data.

“For value-based payment models to work, 94 percent of health plans agree that they are going to have to exchange different types of information than under traditional fee-for-service arrangements,” the report noted.