Slow Progress on Medicare’s Goal of 50 Percent Value-Based Reimbursement by 2018

060916_HealthCatalyst-200Respondents to Health Catalyst survey cite analytics as most important success factor for value-based reimbursement

Fewer than a quarter of U.S. hospitals are on track to hit the Obama Administration’s 2018 goal of providing at least half their patient care through so-called “value-based” arrangements – structures that tie reimbursement from Medicare to the quality of care patients receive.

That is one finding of a new online survey of healthcare executives representing 190 U.S. hospitals with a total of more than 20,000 licensed beds. The survey by Health Catalyst (@HealthCatalyst)revealed that just 3 percent of health systems today meet the target set by the Centers for Medicare and Medicaid Services (CMS). Only 23 percent expect to meet it by 2019, a year after CMS had hoped that half of all Medicare reimbursements would be value-based.

According to the survey, the majority of health systems—a full 62 percent—have either zero or less than 10 percent of their care tied to the type of risk-based contracts identified by CMS as “value-based,” including Medicare accountable care organizations (ACOs) and bundled payments. Not surprisingly, small hospitals with fewer than 200 beds comprised the majority of those reporting no at-risk contracts. A contributing factor may be that smaller hospitals are five times less likely than larger organizations to have access to sufficient capital to make risk-based contracting work, according to the survey.

Despite lagging behind the federal government’s goal, healthcare executives across the board intend to steadily increase value-based care and at-risk contracts. In the next three years, all but 1 percent of respondents expect their organizations to be engaged in at-risk contracts. Sixty-eight percent said they expect risk-based contracts to account for less than half their total care in that time frame. Only 23 percent expect value-based care to account for more than half of their care in the next three years. Eight percent of respondents said they could not predict the answer.

Analytics Tops the List of Must-Haves
The most important organizational element needed for success with risk-based contracting is analytics, said responding executives at both small and large hospitals. In fact, 52 percent of respondents cited the prime importance of analytics, more than double the second most-selected answer: a culture of quality improvement. Twenty-four percent of respondents cited cultural alignment on quality as having the most impact on value-based care success.

“Transitioning from fee-for-service reimbursement to value-based payments is a goal that many healthcare organizations embrace but are having difficulty implementing as they juggle a number of other high priorities,” said Bobbi Brown, Health Catalyst vice president of financial engagement. “This survey reveals that they’re making progress but they could use a little help – some of it financial and some of it technical in the way of better analytics to help identify at-risk populations and better manage their risk. The bottom line seems to be that while progress is slow, healthcare leaders are committed to making value-based care work.”

Survey results reflect the opinions of 78 healthcare professionals who responded to an online survey by Health Catalyst in May 2016. Over half of the respondents (51 percent) were CEOs or CFOs of large hospital-owned physician groups and hospitals ranging in size from 15 acute care beds to over 1,000 beds. The remaining respondents all held executive roles, including several Chief Medical Information Officers, Chief Medical Officers and Chief Nursing Officers.

The organizations represented include many well-known multi-hospital and multi-state health systems with a cumulative 756 inpatient and outpatient facilities and 20,416 acute care beds.