The promises of value-based payment models have been touted for years, and all signs point to provider groups and health systems taking on more risk. A recent study by the American Medical Group Association (AMGA) shows “medical group leaders are carefully assessing their entrance into or increased participation in risk-based arrangements” and cites that groups are expecting Medicare Fee-for-Service (FFS) payments to decline by 17% this year and commercial FFS to decline by 11%.1 The same study reports multispecialty medical groups expect to increase shared risk revenues by 400%.
Similarly, a recent survey by Sage Growth Partners indicates nearly 90% of independent physician groups plan to increase participation in risk-based payment models, such as bundled payment programs, with 30% of those doing so within the next year.2
Yet provider groups and health systems’ experience and results with new programs vary, and they face real limitations accessing data and developing the infrastructure and engagement necessary to succeed under new paradigms. They are spending significant resources on measuring performance for multiple new payment models but are experiencing mixed results.
Although it is too early to come to conclusions about the effectiveness of new payment models introduced over the past few years, simply flipping from FFS to risk-based reimbursement doesn’t automatically lead to improved clinical and financial performance, and doesn’t immediately incentivize physicians to get on board with change.
The current state of performance management is leaving provider groups and health systems unprepared to reach their goals of improving patient outcomes, optimizing reimbursement, and increasing stakeholder value.
The Sage Growth Partners study showed that independent physician organizations are more focused on the process of reporting performance than knowing how they are actually performing. And although more than 90% of groups report measuring physician performance, fewer than half have strategies in place to measure against clinical best practices — a method proven to resonate with frontline physicians.
In fact, two-thirds of respondents said that physician engagement is one of their top challenges. Aggregating and analyzing data accurately are other top challenges. You can’t have one without the other. The data aggregation and accuracy is paramount to driving physician engagement.
Even with a solid and credible foundational analytics platform, too often, today’s physician performance metrics measure the wrong things, and many payer-established quality measures don’t help physicians deliver better care to patients. Simply measuring things to check off a quality metric for an insurance company should not be the goal. For example, requiring specialists to report on flu shots is a waste of time and an irrelevant measure of quality. High performing provider groups and health systems must go beyond the minimum measures required by payers.
High-value care must focus on true outcomes measurements and provide physicians with data that supports their efforts to improve those outcomes, not merely enabling them to check a box so they can get a bonus payment. That’s especially critical when looking at true risk-based payments — those that go beyond meeting quality benchmarks and balance cost effectiveness and access to care. With these higher risk models, physicians need insights not only into how they deliver care, but also how the analytics system they leverage delivers insights. This level of performance management goes well beyond meeting quality metrics to drive high-value care.
The significant planned increase in participation in true risk-based payment models calls for greater transparency and greater focus on physician performance management within provider groups and health systems that extends beyond their four walls. This emphasis on transparency and performance management is critical to engaging physicians in delivering high-value care and doing well under any reimbursement arrangement.
Check out our latest whitepaper for a more in-depth take on getting physicians on board with performance management to make change a reality. You will learn strategies help you reap the benefits of delivering high-value healthcare such as identifying and implementing ‘best practices’ that reduce cost and improve patient outcomes, and driving higher margins from alternative payment models, such as Bundled Payments for Care Improvement-Advanced (BPCI-A).
At ArborMetrix, advancing healthcare through data science is our mission, and delivering high impact, intuitive technology and analytics is our passion. Our leading healthcare analytics solutions are proven to deliver targeted, clinically-deep insights that improve clinical outcomes, optimize financial performance, increase stakeholder value, and measure the real-world effectiveness of treatments and procedures, as well as medical device technologies. The ArborMetrix Performance Management Solution arms provider groups and health systems with the tools they need to deliver high-value healthcare, simplify their participation in value-based care, and chart their own course with alternative payment models.
1. “Taking Risk, 3.0: Medical Groups Are Moving to Risk … Is Anyone Else?” AMGA’s Third Annual Survey on Taking Risk. American Medical Group Association (AMGA). December, 2017.
2. “Large Independent Physician Organizations - A Sage Growth Partners Research Study.” Sage Growth Partners. December 20, 2017.
"We now have a platform that has the power to deliver the same clinically meaningful metrics from the senior executive level down to individual providers."
SVP, Business Intelligence and Analytics, Sound Physicians