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10 Key Payer Trends from 2018 to Watch in Value-Based Care

Coming up at Congress

Healthcare costs are following an unsustainable trend, and traditional delivery models are exacerbating the problem. At ACHE’s Congress on Healthcare Leadership, learn how Mayo Clinic’s Department of Laboratory Medicine and Pathology identified problems in its practice that were driving unnecessary costs and designed a strategy to set it on a sustainable path.

Better Care, Lower Cost

Within the Affordable Care Act’s equation to deliver quality patient care at reduced costs, providers and payers alike are feeling the effects of this historical healthcare transition. It’s been eight years since the ACA was signed into law and the implementation of this law has not been without its challenges. But have the results so far been worth the challenges? Let’s look at the payer side of the ACA equation.

According to a study conducted with 120 payers, the answer would be “yes.”  HIT Consultant recently recapped “Finding the Value: The State of Value-Based Care in 2018,” a national study and the third in a series commissioned by Change Health and conducted by ORC International. Good news. Study results indicate mostly positive results for payers.

Here are the highlights:

  1. Cost Savings: 5.6 percent medical cost savings tied to value-based strategies; 37 percent of respondents reported savings of 5.0-7.49 percent; 25 percent of respondents, reported over 7.5 percent in savings
  2. Payers reporting improvements toward the “Triple Aim”: Care quality, 80 percent; patient engagement, 73 percent; provider relationships, 64 percent
  3. Adoption, advancement and innovation of value-based care models and strategies are being led by commercial lines of business.
  4. Fee-for-service reimbursement declined to 37.2 percent of total reimbursements, faster than predicted.
  5. Innovation and speed lacking for launching new episodes of care: 3-6 months to launch, 21 percent of payers; up to one year, over 33 percent; 18 months, 21 percent; up to 24 months, 13 percent
  6. Provider engagement lacking for episode-of-care programs: 43-58 percent of payers report provider engagement is very or extremely difficult.
  7. Payers investing in support staff for future growth: 66%, driven by exceptional medical cost savings realized.
  8. Episode-of-care models seen as effective: 33-50p of payers rated models as very to extremely effective for improving care quality.
  9. Consistent cost savings across all episodes-of care.
  10. Dissatisfaction with value-based analytics, automation and reporting capabilities; 50 percent of payers reported they’re not very satisfied with current systems.

Read the full recap on HIT Consultant.

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