After the Covid-19 pandemic suspended several procedures, the health system is seeking to diversify risk-based payment models next year. According to a survey of more than 100 provider CFOs and managed care executives, most of them want to enter the Medicare Advantage model.
This survey, conducted by the Healthcare Financial Management Association and produced by Guidehouse, found that vendors are seeking to adopt a wide range of risk-based payment strategies. Although the Medicare Advantage plan is the most popular option, the health system is also considering other payment models in 2022. The following is a breakdown of their response:
- Medical insurance advantage (59%)
- Risky contracts based on commercial employers (52%)
- Alternative payment model for medical insurance (49%)
- Managed Medicaid (36%)
- Partnerships directly to employers (33%)
“Although the traditional payer and provider relationship has been impacted in this evolving market, what we see effective is the payer model that creates value for the two entities,” Guidehouse Director Travis Sherman, Said in the press release. “The one-size-fits-all,’I win you lose’ approach is no longer a good business model. Industry disruption has created new opportunities for the health system to rethink the structure of its payer and provider partnerships for willingness to innovate together Of new entrants re-evaluate their market and re-adjust their network strategy to suit their market development direction.”
Although the interests may be mutual, there are still some challenges to achieve this goal. The health system stated that their biggest external challenge in pursuing the “payer” model is to establish a strategic partnership with the payer.
At the same time, their biggest internal challenges are data and technology costs, completeness, and reporting. About half of the respondents said they plan to build these functions internally, while 30% said they will work with health plans for these functions, and 21% plan to outsource them to a third-party provider.
Dr. Nicole Fetter, Director of Guidehouse, said at the press conference: “Unfortunately, due to the challenges of operating and implementing a risk-based model, many well-meaning payers and providers have never achieved partnerships.” “To overcome these obstacles and Success requires organizational commitment, a cohesive governance structure, and sufficient investment in strong data-driven infrastructure.”
It’s worth noting that health system leaders also pay close attention to industry disruptions that they see as potential barriers to success. Their biggest concerns are vertically integrated health plans, such as UnitedHealth Group’s large supplier network, and consumer-facing companies such as CVS and Amazon.
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