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Roadblocks for implementing value-based healthcare


While there may be a stake in the heart of the fee-for-service payment model, replacing it with value-based healthcare won't be easy since stakeholders face obstacles in the way of this change, BenefitsPro reported.

Instead of paying providers for every service they render, the value-based model would pay them based on patient outcomes. Sixty-four percent of payers recently surveyed reported being on track to make the leap to value-based reimbursement. Insurers are starting to view value-based care as "a way of getting a handle on the totality of [healthcare] costs," Kaiser Permanente's Jack Cochran told FierceHealthPayer in an exclusive interview.

But one problem in transitioning to this model is defining what value is, how to measure it and how to reimburse for it. Not every program that calls itself value-based improves health; some of these programs are just cost-shifting by another name, according to BenefitsPro.

Care coordination isn't easy to achieve in the healthcare system as a whole due to a lack of collaboration, BenefitsPro reported. While insurers are developing incentives for doctors to coordinate care, "the necessary infrastructure to facilitate collaboration and alignment is woefully inadequate," the article noted. Care coordination requires addressing socio-economic determinants of health including housing, jobs, diet and transportation. That's new territory for doctors and hospitals.  

Another complicating issue is that to structure value-based payments, payers must collect data on high-quality, low-cost network providers; but metrics that measure these factors can differ by product and insurer, BenefitsPro reported.

Getting doctors to agree on best-practices can also be challenging. Even when there are evidence-based, peer-reviewed protocols for procedures, standardization of care isn't always possible given the unique health issues some patients present, the article added.

Finally, "one of the worst-kept secrets in the industry is that many payers are running on old technology- systems that are 20-, 25- 30 years old," Ray Desrochers, executive vice president of the software company HealthEdge, told BenefitsPro. Many payer and provider practice management models aren't designed for value-based models.

For more:

- read the BenefitsPro article


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