- Some 48 states now use some form of value-based payment model, a seven-fold increase from five years ago, according to a new report commissioned by health IT firm Change Healthcare.
- More than 20 states evolved their models since last year's report. Though patient-centered medical homes are the most popular form of value-based model, the program that's gained the most traction over the past 18 months is CMS' Comprehensive Primary Care Plus, a primary care medical home model.
- The report highlighted three states (New York, Pennsylvania and Vermont) as leading the way away from fee-for-service payment methods. Four states have no official value program: Georgia, Indiana, Mississippi and West Virginia. Researchers found that 34 states have initiatives that are two years or older and six states have had programs underway for four years or longer.
Federal health policy is often in the spotlight, especially as Democratic 2020 presidential contenders propose expanding Medicare or moving to a single-payer program. States, however, have laws and regulations covering much of the healthcare landscape. They can also serve as laboratories for alternative payment models, giving researchers a chance to gauge how well programs work before they get a nationwide rollout.
CMS has been pushing more programs that pay hospitals and physicians for the quality, rather than quantity, of their work. While Medicare has been a main focus, states and Medicaid managed care plans also have their opportunities.
"Much of the public's attention is focused on the federal government's role in catalyzing healthcare payment reform, but the significant work being done at the state level is no less important and meaningful," Carolyn Wukitch, senior vice president and general manager for network and financial management at Change Healthcare said in a statement accompanying the findings. "Based on the report, it's obvious that managed Medicaid programs are actively exploring numerous VBP models, and that states implementing more advanced strategies around healthcare payment transformation will ultimately drive the commercial markets."
Providers still need prodding to participate in value-based models, even though few would argue they aren't needed. A recent survey of healthcare executives from Numerof & Associates found that most respondents said 10% or less of their revenue came from risk-based contracts.
Part of the reticence stems from what executives view as a lack of data sharing capability, no agreement on outcome measures and a dearth of incentives for collaboration between payers and providers, according to a March survey from Change Healthcare.