Obstáculos de la manera de relaciones valor-basadas

por Lauren Dubinsky, Senior Reporter | July 31, 2014
Distrust and an unwillingness to accept financial risk are standing in the way of value-based relationships between health care payors and providers, according to a recent FTI Consulting, Inc. study.

Out of the 251 providers in the study, only 16 percent said that they are willing to accept the financial risk associated with entering into a value-based relationship with insurers. Additionally, 41 percent of the primary care physicians who are not in a value-based relationship said that their distrust of payors is what's stopping them.

"This lack of trust will be a huge hurdle for payers to overcome as they often cite provider buy-in and engagement as critical to the success of any value-based arrangement," Dr. Phil Polakoff, senior managing director and chief medical executive of the health solutions practice at FTI Consulting, said in a statement. "The two groups are still significantly distant in attitudes towards value-based arrangements — a difference that can stand in the way of creating new forms of payment."

Ever since the Affordable Care Act was introduced, both payors and providers have been getting ready for the switch to value-based reimbursement programs through Accountable Care Organizations, bundled arrangements and new relationships.

A lot of experts think that for bundled payments and value-based agreements, payors and providers must share risks in order to control costs and improve quality. But that's not the way that it is — out of the 20 different U.S. payors interviewed for the study, only 5 percent believe that providers will accept the risks.

However, that's not the only problem — 80 percent of the payors want providers to invest in health care IT, specifically systems for clinical integration and population health management. But only 50 percent of the providers have implemented that technology.

Despite all of that, most of the payors and providers are making strides to get ready for value-based arrangements that are incentivized by the ACA. A vast majority — 80 percent of the payors — think that it's very important and 92 percent of the providers think that it's somewhat or very important.

But for now the traditional fee-for-service contract is still the dominant model — 55 percent of the payors have fee-for-service commercial contracts and 15 percent of the providers report that they are "only interested" in the fee-for-service reimbursement model.

"Despite their disagreements, payers and providers overwhelmingly recognize the importance of value-based arrangements to promote their broader strategic objectives," Ed Harnaga, senior managing director and Americas head of the strategic communications segment's health care and life sciences industry team said in a statement.

"Overcoming the trust deficit will require both parties to work together on sharing risks, communicating effectively, building capabilities and investing in technologies to move the industry forward."

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