Transforming Payer Infrastructure to Accelerate Value-based Care

While the trend toward value-based care is promising, research shows it can take a long time for healthcare payers to effectively implement the model. Value-based programs require an infrastructure that enables the many-to-many relationships between value-based care stakeholders and their counterparts.

There’s good news and bad news when it comes to the evolution of value-based care in the U.S. Let’s start with the good news. A 2021 study from the Health Care Payment Learning and Action Network (HCPLAN) shows a continued move from fee-for-service models to value-based care (VBC). According to the study, 39.3% of healthcare dollars spent are tied to traditional fee-for-service payments, 19.8% are tied to pay-for-performance, and 40.9% are part of some type of value-based contract (e.g., shared savings, shared risk, bundled payment, population-based payments, etc.).¹

Now for the bad news. While the trend toward VBC is promising, research also shows it can take a long time for healthcare payers to effectively implement these new payment models. According to a 2018 study, only 21% of payers say they can roll out a new episode of care in three to six months, more than 33% say they need a year, 21% need 18 months, and 13% require two years or more.²

This inconsistent implementation pace can impact the overall adoption and success of VBC programs nationwide. Addressing this issue requires resolving several universal challenges that currently hinder the ability for many healthcare payers to quickly implement new VBC payment models.