By Clive Riddle, October 3, 2014
Catalyst for Payment Reform has just released their second annual National Scorecard and California Scorecard on value based payments and payment reform made to providers by purchasers, funded by The Commonwealth Fund and the California HealthCare Foundation.
The universe they utilized to track and measure provider payments was based on the National Business Coalition on Health’s eValue8 health plan survey platform, in partnership with NBCH and these business coalitions: the Colorado Business Group on Health, HealthCare 21, the Memphis Business Group on Health, the Mid-Atlantic Business Group on Health, the Northeast Business Group on Health, the Pacific Business Group on Health, and the Washington Health Alliance.
What meets their definition of value oriented payments? They say they are in-network payments that are “either tied to performance or designed to cut waste” and that 40% of commercial payments meet this definition. What makes up the other 60%? They say payment types without quality incentives that include “traditional feefor-service (FFS), bundled, capitated and partially capitated payments.”
What comprises the 40% that is value oriented? Quality incentive driven Bundled Payments (0.1%) + Non FFS Shared Savings (0.2%) + Non FFA Non-Visit Payments (0.6%) + Shared Risk (1.0%) + Partial or Condition Specific Capitation (1.6%) + FFS and Shared Savings (2.0%) + FFS Based Pay and P4P (12.8%) + Full Capitation (15.0%) + All Other (6.7%) = 40.0%.
Here’s more of the numbers shared in this year’s scorecard:
- 53% of value-oriented payments put providers at some financial risk if they fail to improve care or spend over budget
- 38% of payments to hospitals are value-oriented,
- 10% of payments to specialists and 24% of payments to primary care physicians are value oriented
- Of these value-oriented payments to physicians, 71% of the total goes to specialists, and 29% to PCPs
- 15% of participating health plans’ patient members are formally “attributed” to a provider participating in a payment reform contract