Health IT Pulse

Dec 10 2015   12:14PM GMT

Health plans moving quickly to value-based payments

Shaun Sutner Shaun Sutner Profile: Shaun Sutner

Tags:
ACO
medicaid
Medicare payments
Wearable devices

Health insurance payers are accelerating their move to value-based payments at a remarkable rate, according to a new survey by HealthEdge, a vendor of financial-administrative-clinical software systems for health insurers.

For its fifth annual “State of the Payor” survey, HealthEdge polled 100 senior executives at payer organizations and found that 80% of health plans following Medicare are shifting to value-based payments, a dramatic jump from the 50% that were adopting value payments when the survey first launched in 2011.

The survey also revealed a robust tilt toward technology and IT in the industry, with 73% of the insurance execs reporting they are planning “major, technology-driven transformation at their organizations,” Ray Desrochers, HealthEdge executive vice president, said in a release.

“The transition to a digital business is now required to provide members with the consumer-friendly, retail-like experiences they expect, effectively participate in new healthcare business models and drive new levels of operational efficiency,” Desrochers said.

Other key findings:

  • Payers’ support for accountable care organizations (ACOs) is decreasing, from a high of 69% a few years ago to 55% this year
  • Mobile technology (69%) and social media (59%) figure prominently in payers’ plans, while wearable health technology devices still are of only modest interest (20%)
  • A majority of payer organizations still manually process 20% to 40% of claims, showing that while automation is the rule, paper claims still are abundant
  • For managing patients, payers are prioritizing innovative care coordination strategies, such a social media engagement and mobile capabilities

Over the next three years, payer organizations are planning to support or participate in:

  • Value-based benefits (rewarding members for what insurers consider) healthier choices), 48%
  • Value-based payments, 80%
  • ACOs, 55%
  • Next-generation consumer-directed health plans, which actively encourage patients to manage their own health and healthcare spending, 36%
  • Medicare and Medicaid expansion, 77%
  • Insurance exchanges, 68%
  • Enhanced care management, disease management and utilization management programs, 51%

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