Decision support is a key factor in implementing value-based reimbursement

More than two-thirds of payments are expected to be based on value measurement in five years, up from just one third today according to McKesson’s new report, The 2014 State of Value-Based Reimbursement. One of the keys to being successful in that transition to value is having the right solutions in place, explains Medical Director David Nace, M.D., in his executive summary of the report.

“Value-based reimbursement models, especially when implemented as mixed reimbursement models — which is the current industry direction—are too complex and costly to design, administer, manage, measure, and scale without the right tools. “One of the key factors is the decision support system that can help payers, providers, clinicians, and even patients to use clinical evidence, as well as provider network and cost implications, to help make informed decisions at the point of care.”

The independent research study of 464 payers and providers conducted by ORC International also reveals that healthcare transformation is painstaking work. Existing systems are being pushed to the breaking point, and administration of these new models requires next-generation healthcare IT to make them automated, scalable, and cost efficient. Dr. Nace advises stakeholders on the seven steps payers, providers, and clinicians can take today to start aligning towards value-based reimbursement models.

Key findings of The 2014 State of Value-Based Reimbursement study include:

• Payers and hospitals are aligned on embracing payment with value measures. Ninety percent of payers and 81% of hospitals now offer a mix of fee-for-service (FFS) and other reimbursement models. Those payers expect fee-for-service (FFS) to decrease from 56% today to 32% in five years. Hospitals using mixed models agree, projecting FFS will decline from 57% today to 34% in five years. Essentially, payers and hospitals anticipate two-thirds of payment will be based on complex reimbursement models with value measures by 2020.
• Alignment with value-based reimbursement adoption varies depending on what the region looks like. Collaborative regions, where one or two payers and hospitals are market leaders, are closer to value-based reimbursement. Fragmented regions, where there are multiple payers and hospitals and no clear market leaders, are closer to fee-for-service models.
• All key obstacles payers and hospitals “urgently need” to overcome are technology related, led by the need to integrate internal, vendor, and collaborative IT systems (41% payers, 23% hospitals); and data collection, access, and analytics (22% payers, 20% hospitals).

To read the full white paper and access a wealth of data that can have a significant impact on your strategic planning, DOWNLOAD it here.