Health Leaders Cite Limited Ability to Share Clinical Information as Key Obstacle to Value-Based Payment

A Healthcare Financial Management Association (HFMA) study sponsored by Humana Inc. (NYSE: HUM) finds continued progress for value-based care and interoperability, yet key barriers remain: 

• Adoption of payer value-based programs may be somewhat slower than expected, though they have doubled since 2015.
• External and internal interoperability may be a primary focus of providers in the coming years, due to current shortcomings, anticipated future need, and the increasing demand for access to various sources of data.
• Almost three-quarters of executives (74 percent) report their organizations have achieved positive financial results (i.e., return on investment) from value-based payment programs to date.

Transformation of the nation’s health care payment system is being slowed by limited capabilities for sharing clinical information among hospitals, physicians, and health plans, according to a study conducted by the Healthcare Financial Management Association (HFMA) and sponsored by Humana. The study surveyed senior financial executives about their organizations’ value-based payment readiness.  

Interoperability is still a critical focus

Nearly three in four (74 percent) of executives surveyed in this follow-up study cite interoperability, the need to improve capabilities for aggregating clinical information across networks and between hospitals and physicians, as an extremely important need. Concerns about interoperability have increased since the original study was conducted in 2015. That study found 68 percent of respondents rated interoperability as an extremely important need at that time. Additionally, half of respondents in the 2017 study describe interoperability improvement across health networks with health plans as extremely important.  

The results are also similar to a study by the American Academy of Family Physicians, sponsored by Humana, which found that value-based care continues to make progress but faces challenges. Researchers also found that value-based payment adoption among health care providers has increased and return on investment (ROI) has improved since the original study was conducted in 2015.  

Momentum continues to grow for value-based care

Highlights of findings from the 2017 study include the following:

• Health plans’ use of value-based mechanisms has increased from 12 percent to 24 percent since 2015. In 2015, however, utilization of value-based mechanisms by health plans was projected to reach 50 percent in 2018.
• Penetration of value-based payment in negotiated governmental plans (i.e., Medicare Advantage and managed Medicaid plans) came in at 26 percent in 2017, compared to 21 percent in traditional Medicare and 14 percent in non-managed Medicaid plans.
• 74 percent of respondents report their organizations have achieved positive financial results from value-based payment programs to date. This is higher than the 51 percent of executives reporting positive financial results in 2015.
• About three-quarters of respondents stated that regulatory uncertainty, including MACRA, has a negative effect on their ability to forecast the financial impact of value-based payment. MACRA, the Medicare Access and CHIP Reauthorization Act, encourages physicians and other eligible professionals to participate in alternative payment models that would hold them accountable for quality and cost of care. 

Beyond limited ability to access, collect, and manage clinical data, respondents also note the following as significant challenges related to value-based payment: 

• Lack of resources (both staffing and financial resources)
• Inconsistencies among payers (i.e., measures, access to data from payers, contracting)
• Lack of physician alignment and support

Chronic care and social determinants must receive more resources

Despite the continued rise of seniors living with multiple chronic conditions that require specialized care, many respondents state they do not have the means to assist. Sixty-five percent of respondents report their organizations do not have tools/technology to assist in specialty and/or inpatient care to help control/manage costs. A majority of respondents also view chronic care management as a significant readiness gap in the next three years.  

“Interoperability has the challenge of collecting fragmented health data and exchanging the information across multiple systems. In addition, it must provide physicians access to comprehensible patient health information at the right time for informed decision making and better efficiencies. Overcoming the interoperability barrier becomes even more important for treating patients with chronic conditions as they generally see multiple physicians and specialists,” says Roy Beveridge, MD, Humana’s Chief Medical Officer.     

Some hospitals are developing capabilities to gather data and address social needs. However, leveraging social determinants of health remains a challenge. More than six in 10 respondents (63 percent) report that their organizations do not consider social determinants of health, such as food insecurity, in their overall strategy and cost planning.  

Provider-based finance executives participating in the study called on health plans to facilitate growth of value-based payment by developing smarter incentives that are aligned with provider needs and care objectives, sharing their data with providers, committing to transparency in the spirit of partnership, and standardizing programs, measures, and processes.  

“Collaboration among health systems, physicians, and health plans is the key to growing value-based payment,” says HFMA President and CEO Joseph J. Fifer, FHFMA, CPA. “Technology and other obstacles can be overcome if all stakeholders commit to working together for the benefit of the people we serve.”

The survey, conducted in September 2017, was sent to 1,100 financial executives in hospitals and health systems. Responses were received from 117, a response rate of 11 percent. 

About HFMA

The Healthcare Financial Management Association (HFMA) is the nation’s premier membership organization for healthcare finance leaders. HFMA builds and supports coalitions with other healthcare associations and industry groups to achieve consensus on solutions for the challenges the U.S. healthcare system faces today. Working with a broad cross-section of stakeholders, HFMA identifies gaps throughout the healthcare delivery system and bridges them through the establishment and sharing of knowledge and best practices. We help healthcare stakeholders achieve optimal results by creating and providing education, analysis, and practical tools and solutions. Our mission is to lead the financial management of health care.   

About Humana

Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.  

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools—such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions—combine to produce a simplified experience that makes health care easier to navigate and more effective.  

More information regarding Humana is available to investors via the Investor Relations page of the company’s website, at www.humana.com, including copies of:  

• Annual reports to stockholders
• Securities and Exchange Commission filings
• Most recent investor conference presentations
• Quarterly earnings news releases and conference calls
• Calendar of events
• Corporate Governance information

For Medicare lines of business, Humana is a Medicare Advantage HMO, PPO, and PFFS organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. The provider network may change at any time. Impacted members receive notice when necessary.