Note: This is an authorized excerpt from 2015 Healthcare Benchmarks: Value-Based Reimbursement. To download the entire report, go to

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1 Note: This is an authorized excerpt from 2015 Healthcare Benchmarks: Value-Based Reimbursement. To download the entire report, go to or call

2 2015 Healthcare Benchmarks: Value-Based Reimbursement In this inaugural survey on value-based reimbursement, 81 healthcare organizations describe payment transformation efforts, favored models, patient and provider populations, provider metrics, supporting tools and technologies, challenges and impacts, annual savings, and much more. Value-based purchasing is here to stay. The key point to success is memberprovider engagement. We are moving away from fix and repair healthcare to promote prevention. > Health Plan We are at an early stage on implementation; our greatest success for now is better preventive care. > Independent Practice Association [Our greatest success was] first-year savings on a commercial shared savings agreement of $2.8 million on 50,000 lives. > Large Primary Care-Driven Provider Organization [Value-based purchasing] is the way of the future, and we anticipate having 50 percent of our population covered under value-based purchasing in the next 30 months. > Health Plan 2015, Healthcare Intelligence Network 2

3 2015 Healthcare Benchmarks: Value-Based Reimbursement This special report is based on results from the Healthcare Intelligence Network s inaugural industry survey on Value-Based Reimbursement conducted in October Executive Editor Melanie Matthews HIN executive vice president and chief operating officer Project Editor Patricia Donovan Document Design Jane Salmon 2015, Healthcare Intelligence Network 3

4 Table of Contents About the Healthcare Intelligence Network... 6 Executive Summary... 6 Survey Highlights... 7 Key Findings... 7 Program Components... 7 Results and ROI...8 Successes Resulting from Value-Based Reimbursement Programs...8 About the Survey... 8 Respondent Demographics... 9 Using This Report... 9 Responses by Sector...10 The Hospital/Health System Perspective The Health Plan Perspective Respondents in Their Own Words...14 Most Effective Tool, Workflow or Protocol Greatest Value-Based Successes Achieved to Date...15 Final Thoughts Conclusion...16 Responses to Questions Figure 1: All - Existing Value-Based Payment Models Figure 2: All - Future Value-Based Payment Models Figure 3: All - Preferred Value-Based Models Figure 4: All - Associated Contracts Figure 5: All - Number of Covered Beneficiaries...20 Figure 6: All - Number of Reimbursed Physicians...20 Figure 7: All - Percentage of Compensation Tied to Value Figure 8: All - Provider Metrics to Determine Payment Figure 9: All - Tools Supporting Value-Based Models Figure 10: All - Components of Value-Based Models Figure 11: All - Annual Savings from Value-Based Payments Figure 12: All - Greatest Challenge of Value-Based Reimbursement Figure 13: All - Program Impact...24 Figure 14: All - Adequate Support for Provider Success...24 Figure 15: All - Organization Type Figure 16: Hospitals - Existing Value-Based Payment Models Figure 17: Hospitals - Future Value-Based Payment Model...26 Figure 18: Hospitals - Preferred Value-Based Models...26 Figure 19: Hospitals - Associated Contracts Figure 20: Hospitals - Number of Covered Beneficiaries Figure 21: Hospitals - Number of Reimbursed Physicians...28 Figure 22: Hospitals - Percentage of Compensation Tied to Value , Healthcare Intelligence Network 4

5 Figure 23: Hospitals - Provider Metrics to Determine Payment Figure 24: Hospitals - Tools Supporting Value-Based Models Figure 25: Hospitals - Components of Value-Based Models Figure 26: Hospitals - Annual Savings from Value-Based Payments Figure 27: Hospitals - Greatest Challenge of Value-Based Reimbursement Figure 28: Hospitals - Program Impact Figure 29: Hospitals - Adequate Support for Provider Success Figure 30: Health Plans - Existing Value-Based Payment Models Figure 31: Health Plans - Future Value-Based Payment Models Figure 32: Health Plans - Preferred Value-Based Models Figure 33: Health Plans - Associated Contracts Figure 34: Health Plans - Number of Covered Beneficiaries Figure 35: Health Plans - Number of Reimbursed Physicians Figure 36: Health Plans - Percentage of Compensation Tied to Value Figure 37: Health Plans - Provider Metrics to Determine Payment Figure 38: Health Plans - Tools Supporting Value-Based Models Figure 39: Health Plans - Components of Value-Based Models Figure 40: Health Plans - Annual Savings from Value-Based Payments Figure 41: Health Plans - Greatest Challenge of Value-Based Reimbursement Figure 42: Health Plans - Program Impact Figure 43: Health Plans - Adequate Support for Provider Success Appendix A: 2015 Value-Based Reimbursement Survey Tool , Healthcare Intelligence Network 5

6 About the Healthcare Intelligence Network The Healthcare Intelligence Network (HIN) is an electronic publishing company providing high-quality information on the business of healthcare. In one place, healthcare executives can receive exclusive, customized up-to-the-minute information in five key areas: the healthcare and managed care industry, hospital and health system management, health law and regulation, behavioral healthcare and long-term care. 72% of survey respondents use some type of valuebased payment model. Executive Summary Healthcare s inevitable shift from volume- to value-based reimbursement is reflected not only in Medicare s alternative payment time line but also in the growing number of commercial payors now rewarding providers based on the quality of care they deliver instead of the number of services and procedures they perform. And judging by responses to an inaugural survey on value-based reimbursement, healthcare organizations are reacting to this movement: 71 percent of survey respondents employ a value-based reimbursement or alternative payment model. The October 2015 survey by the Healthcare Intelligence Network also determined that of those respondents that have not yet explored a fee-for-value approach, 26 percent plan to do so in the coming year. In assessing value-based payment formulas, 56 percent of respondents favor a pay-for-performance model, with 71 percent employing these models in contracts for commercial populations. Despite healthy adoption of alternative payment approaches, one quarter of respondents say the infrastructure required to support value-based payment is the most significant hurdle of these emerging models greater even than the challenge of data integration or patient engagement, the survey determined. In evaluating healthcare providers for value-based rewards, respondents most often review markers tied to quality (82 percent), hospital readmissions (56 percent) and patient satisfaction (56 percent) to determine payment, the survey found. The use of physician report cards to track provider performance was reported by 63 percent of respondents. The shift toward fee-for-value has had the greatest impact in the area of prevention. Sixty-nine percent attributed a rise in preventive care to value-based reimbursement programs. Most effective workflow: Physician leadership, risk appetite, and proper capabilities. 2015, Healthcare Intelligence Network 6

7 Respondent Demographics Responses to the October 2015 survey on Value-Based Reimbursement were submitted by 81 organizations. Of 77 respondents identifying their organization type, 24 percent were hospitals or health systems; 20 percent were health plans; 20 percent were service providers; 12 percent were post-acute care, 10 percent were physician practices, and 22 percent categorized their organization type as Other. Using This Report This benchmarking report is intended as a resource for healthcare organizations searching for comparable data and means to measure implementation and progress. It is also a helpful planning tool for organizations readying initiatives in this area. The initial charts and graphs presented here represent results from all respondents; images in subsequent sections depict data from high-responding sectors. (Figure titles begin with the segment they represent; for example, All, Health Plans, Hospitals, etc.) Often, one of the largest responding sectors is composed of respondents identifying their organization type as Other. In general, we do not depict results from this segment because it represents a wide range of organization types, including consultants and product vendors. However, you will always find a graph indicating the demographics of respondents. Here are some additional tips for using this report: 99 See how you measure up: Scan this report for your sector, and see how your program compares to others. Note where you are leading and where you are behind. 99 Evaluate your efforts: Think about where you have been focusing your efforts in this area. Look for trends in the data in this report. Look for benchmarks set by your sector and others. 99 Set new goals: Use the data in this report to set new goals for your organization, or to raise the bar on existing efforts. 99 Use it as a reference book: Keep this report accessible so you can refer to it in your work. Use these data to support your efforts in this area. If you have questions about the data in this report, or have feedback for our team, don t hesitate to contact us at info@hin.com or , Healthcare Intelligence Network 9

6% 2015 HIN Value-Based Reimbursement Survey October, 2015 Figure 2: All - Future Value-Based Payment Models In the next 12

8 Figure 1: All - Existing Value-Based Payment Models Does your organization use any value-based reimbursement or alternative payment models? 28.4% Yes No 71.6% 2015 HIN Value-Based Reimbursement Survey October, 2015 Figure 2: All - Future Value-Based Payment Models In the next 12 months, will your organization implement any value-based reimbursement or alternative payment models? 26.1% Yes No 73.9% 2015 HIN Value-Based Reimbursement Survey October, , Healthcare Intelligence Network 18

Insight to Value-Based Care and A Joint Venture Case Study. Whitney Courser SVP, Sales and Marketing

Insight to Value-Based Care and A Joint Venture Case Study Whitney Courser SVP, Sales and Marketing WCourser@nuehealth.com Meet NueHealth 22-year-old, privately held, nationally trusted healthcare partner