6AMGA.ORG FEBRUAR Y 2018
follow create an undue burden. Payers often have different
data submission mechanisms and requirements, which create
an administrative impediment.
Internally, providers report the lack of the infrastructure
needed to assume financial risk is a barrier. For example, the
survey found that the need to invest in electronic medical
records and analytic software, along with the administrative
and financial processes to perform in a risk-based payment
model, prevents the quicker adoption of value-based payments.
Access to the capital needed to invest in the infrastructure
needed for value-based care also is a significant obstacle.
Outside of the administrative and financial barriers to
shifting away from FFS payments, the survey also found a lack
of engagement from commercial payers. For example, 17% of
survey respondents reported they had no risk-based commercial
products available to them. Forty-two percent indicated that less
than one in five plans offered risk-based products in their market.
Incentives for the Risk-Based Market
Relatedly, the effort to transition to value largely is viewed
as the responsibility of providers, while other key industry
stakeholders are comparatively unengaged. While Congress
and the Department of Health and Human Services largely
have mandated risk at the provider level, commercial insurers and other healthcare industry stakeholders have little
incentive to participate in the risk-based market. For commercial insurers, they largely benefit from reduced expenses
when providers invest in the resources needed to improve
care management processes that reduce hospital admissions or length of stay. If providers are to be held responsible,
other industry interests must be part of the transition to
Absent increased involvement from other industry players
and a removal of the structural impediments to taking on
financial risk, the providers who are leading the transitions
Revenue Sources Overall