Posted and filed under Business, Healthcare, Payers.

Providers are still struggling to align with payers in the transition to value-based purchasing. Value-based purchasing is used to measure, report, and reward excellence in health care delivery. To properly incentivize high-quality care, value-based purchasing requires the cooperation of employer purchasers, public sector purchasers, health plans, and providers who are all tasked with assessing care access, quality, cost, and efficiency.

Value-based purchasing, ideally, is a motivational tool for providers to help re-engineer and improve the quality of health care for patients. By offering rewards such as positive public reporting, enhanced payments, and increased market share – quality improvement should be a no-brainer. That said, no system and no strategy will ever be perfect. Providers were wary about the transition to value-based purchasing since the first whispers of its implementation, and the uncertainty has not yet been quelled.

In March of this year, Physicians Practice released a Fee Schedule Survey that elicited responses from 1,124 providers. Among those, only 12.5% predicted that value-based purchasing would improve or positively impact their revenue cycles. A whopping 46.4% reported that they were not sure how the demand-side strategies would improve their revenue cycle, while 29.4% were said to be expected a negative impact.

Now, nearly four months later, providers are still struggling to adopt the value-based purchasing model. Quest Diagnostics and Inovalon conducted a survey similar to the one above, addressing the gaps in process many providers face during the various initiatives to improve healthcare. Results indicate that only 43% of providers have access to the tools and solutions needed to make a smooth transition to value-based purchasing.

This is a slight improvement from the 29% who reported having the tools needed to succeed, but the numbers are still dire. It’s no surprise, considering that perhaps the most widely utilized tools to providers, EHRs, are so limited in their capabilities. 70% of providers feel a though their EHRs have done nothing to advance patient outcomes. There are plenty of point-of-care details that providers need to be mindful of collected and recording, especially more detailed patient histories and data to assist with recording proper diagnostic codes. More advanced EHRs and tools could help providers succeed with little additional effort.

Luckily, organizations like Quest and Inovalon are working towards creating accessible solutions. David Freeman, General Manager of Information Ventures at Quest has gone on record stating:

“We’ve documented progress over the past year, notably with tools available to aid the transition, but work clearly remains… Extending the capabilities of existing technologies, most notably EHRs, and shared HIT [health IT] investments by health plans and providers may speed physician adoption of value-based care.”

Good quality healthcare should not cause bankruptcy, and that’s exactly what value-based purchasing is trying to avoid. Here’s to hoping more health care organizations acknowledge the necessity of this model and begin working on solutions to ease providers into the new reimbursement ecosystem.