The transition to value-based care has stalled, but the unique structure of Medicare Advantage can help payers advance to lower costs and better outcomes.
As America strives for positive changes to the healthcare system, it may find the greatest advancements for value-based care in Medicare Advantage plans.
Over 90 percent of healthcare payers in a small Health Care Payment Learning and Action Network survey said they expected alternative payment models to increase. However, most were unwilling to divorce from fee-for-service entirely. Instead, they expected to move into value-based reimbursement models that were still rooted in fee-for-service structures.
Furthermore, over half of the payments made in 2017 in the commercial sector were value-based reimbursements, according to the Catalyst for Payment Reform Scorecard. But 90 percent of these payments were grounded in fee-for-service structures and only around six percent involved providers taking on downside risk.
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Payers have made many strides forward in recent years toward value-based care, but what will it take for the industry to fully commit?
By reforming their Medicare Advantage plans, hesitant payers may achieve the leverage they need to devote their whole system to value-based care.
Florida Blue, Humana, and Optima Health have been using Medicare Advantage to progress their value-based care initiatives. These payers have distinct structures and serve different populations. Florida Blue is a single-state health plan, while Humana is the second-largest Medicare Advantage plan in the nation and Optima Health is owned by the integrated healthcare delivery system, Sentara.
Source: Health payer Intelligence