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Docs leery of sharing risk with payers in value-based reimbursement

This lack of trust called "a huge hurdle' for insurance companies

Physician distrust of payers is a significant impediment to creating value-based reimbursement programs, according to a new survey from global business advisory firm FTI Consulting.

In fact, 41 percent of physicians who do not participate in a value-based relationship point to distrust of payers as the major reason.

"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," Phil Polakoff, M.D., senior managing director and chief medical executive of the health solutions practice at the firm, said in an announcement.

Eighty percent of payers in the survey say contracts in which payers and physicians share in the savings they achieve for the Medicare program are "very important" to their strategic objectives.

Meanwhile, 92 percent of physicians say they are either "somewhat important" or "very important" to them. Almost half (49 percent) of physicians are interested in upside risk-sharing models. They're eager to reap the rewards of improving quality and controlling costs, but are less confident about sharing risk when it comes to missed targets that could lead to penalties, according to an article on the survey at FTI Journal.

In looking for provider partners in these arrangements, payers seek out providers that have invested in health IT, especially systems and software that support clinical integration and population health management (PHM). Yet only half the physicians surveyed report that their organization has implemented new technology or software to support PHM and value-based reimbursement.

As an example of ways to better engage physicians, Crystal Run Healthcare, a large, physician-owned multi-practice group in New York, used data on diabetes treatments and outcomes to show doctors how inconsistent treatment methods affected cost in quality. Unifying treatment methods drove down patient costs 20 percent in one year, according to the article.

Its suggestions for improving provider-payer relations include making sure provider group has a leader focused on aligning payer and provider goals, sharing clinical and administrative data with both sides, and integrating information systems to operate on a common platform.

Defining what value is in healthcare remains a barrier to transitioning to the new models, as is getting doctors to agree on best practices.

And despite the importance of data in the new models and expectations that providers invest in costly analytics initiatives, "one of the worst-kept secrets in the industry is that many payers are running on old technology--systems that are 20, 25 [or] 30 years old," said Ray Desrochers, executive vice president of the software company HealthEdge.

To learn more:
- read the announcement
- here's the article

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