What’s Happening in Value-Based Reimbursement

Value-based reimbursement has been around for a long time, and there are still a lot of hurdles we have to overcome in that area.

COVID-19 has had far-reaching impacts on our country, from direct impacts in healthcare to negative impacts on the national GDP. With less money coming in from the GDP and no great reduction in spending, these impacts will squeeze the national budget, of which healthcare makes up a significant part.

COVID-19 has also exposed many of the shortcomings of a fee-for-service model, and many health systems are hoping they will return to pre-COVID-19 volumes soon. On the other side of this pandemic, the transition to value-based reimbursement will be even more crucial.

There is genuine interest in the industry to take the next risk-based step to move closer to value-based care, but with no guaranteed ROI, many providers are hesitant to do so.

Our recent Value-Based Reimbursement 2020 report gives insight into crucial data to let us know about our progress toward making value-based reimbursement a reality.

Definitive Data

If you want to know what vendors everyone is using, where technology is stepping in to help, what is still being done manually, and the quality of the data feeds being used, then the data we’ve used in this report from CHIME’s HealthCare’s Most Wired survey will be perfect for you.

A validating piece of information drawn from CHIME’s data is that the majority of providers are looking to their EHR first to drive value-based reimbursement workloads. 

This isn’t earth-shattering news to anybody, but in the healthcare industry, you can’t stand up high enough to look over the fence and see what your neighbor is up to. And especially now that in-person events are practically nonexistent, we can’t go up to another CIO and ask what he or she is doing. CHIME has given us definitive data that rips the metaphorical fence right down.

Another piece of super valuable information is the exact percentages reported by organizations of their revenue that is coming in from value-based contracts. 

You can’t get this information anywhere else. Everyone knows we’re not as far along as we’d hoped to be, but with definitive data, we can take action to make progress.

You can learn more in CHIME’s most recent HealthCare’s Most Wired report.

To give people another viewpoint into the data, this report also includes insights from both our Population Health Management Cornerstone Summit and KLAS Decision Insights. 

As qualitative companions to CHIME’s quantitative data, KLAS’s Population Health Management Cornerstone Summit and KLAS Decision Insights bring in vital commentary from providers on the specific challenges they face and on what vendor purchasing choices they are making and why. 

Lofty Expectations

A decade ago, we expected that by 2020, at least half of all hospital revenue would be coming from value-based contracts. But as with anything new, there were barriers we did not anticipate.

One of the large barriers that has stopped value-based reimbursement from being successful is effectively dealing with social determinants of health. The most anyone was doing to address social determinants of health ten years ago was setting out brochures in a hospital.

Today, we are aware of the glaring lack of transparency needed for doing SDOH well. Integration was something everyone knew was going to be a problem, and it has been even more of a problem than SDOH have been. Our plans a decade ago to address HIE absolutely failed, and only now are we seeing some progress there.

The Next Steps

The industry is struggling with value-based reimbursement. But there are three main fronts where we are taking the necessary next steps now:

1. Interoperability is becoming a focus for improvement.
2. SDOH networks are actually being built and are empowering providers.
3. Care management solutions are starting to bridge the gap between patient care inside and outside of hospitals.

The pressure from the pandemic to make progress in these areas is palpable, and we look forward to seeing the industry make plans to move forward with more value-based reimbursement contracts.

See the full report for more on this topic as well as specifics from CHIME’s and KLAS’ data.

Photo Credit: Adobe Stock, Monkey Business