Private Payers Outpace Public Insurance in Value-Based Care Push

Private payers are leading the charge away from fee-for-service reimbursement. These parties are more likely than public payers to participate in value-based reimbursement models, according to the latest report from Insights by Xtelligent Healthcare Media.

Payer Perceptions of Value-Based Care aimed to understand challenges and opportunities in effective payer-provider relationships during value-based care contracting. The survey highlighted four key areas: value-based care models, resources needed from providers to assist payers in value-based care efforts, payer confidence in their provider partnerships, and the impact of COVID-19 on provider partnerships.

Despite the healthcare industry’s push towards value-based care, fee-for-service remains most common reimbursement model according to 83 percent of all survey respondents.

"Fee-for-service has always been the way healthcare is delivered. When you look purely from a business standpoint, there is no incentive for the physician to have the patient get better,” said a senior clinical consultant at a national managed care organization during qualitative follow-up. “I know that’s not true. Physicians always want patients to get better.”

Among 107 respondents, public payers emerged as the leaders away from fee-for-service as these organizations were more likely to be involved in more advanced payment models.

The more complex and riskier a model becomes, the further the divide between private and public payers. Fifty-eight percent of private payers reported participating in bundled payment models, compared to 32 percent of public plans. Over half (57 percent) of private payers were participating in accountable care organization reimbursement models, compared to only 26 percent of public payers.

But even riskier models showed a starker divide: 52 percent of private payers participated in shared loss agreements, but only 11 percent of public payers reported the same.

Public payers were less likely to be involved in heavy, risk-based reimbursement models, yet all payers were confident in the impact value-based care would have on their organization’s financial health. Eighty-three percent of all survey respondents agree or strongly agree with that sentiment.

No one strongly disagreed and only three percent of respondents disagreed with the statement: value-based reimbursement would positively impact my organization’s financial health.

Private payers seemed less hesitant to dive into riskier reimbursement models. However, there was broad and overwhelming agreement that value-based reimbursement was beneficial to an organization’s financial well-being, regardless of payer or provider type.

“We're slowing the growth of the costs over time, so we're seeing some resistance,” said the manager of innovative payment models at a regional, non-profit health plan during qualitative follow-up. “There’s a practical matter that makes it difficult for providers to think about loss of revenue in the short term for the promise of getting dollars later on.”

For the industry to further move away from fee-for-service reimbursement models, payers and providers must continue collaborating to ensure the success of innovative, risk-based reimbursement models. Private payers cannot take this on alone, so further alignment across the payer market will improve the industry’s goal towards more value-based care.

Payer Perceptions of Value-Based Care highlights payer participation in innovative payment models, payer trust levels in provider partners, and the impacts of COVID-19 on payer-provider relationships. The full report can be found here.