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9 in 10 Health Plans Still Tied to FFS Model

Rene Letourneau, for HealthLeaders Media, March 27, 2013

While the 10.9% reflects progress from 2010 when only 1% to 3% of payments were value-oriented, Delbanco says there remains a great deal of room for improvement. "As you can see, we've made a fair amount of progress … We commend all the stakeholders in healthcare who have made that progress, but you can see this is also a call to action… There is no doubt in my mind that these results will keep the conversation going."

Other key scorecard findings include:

  • Of the 11% of value-oriented payments, 43% offer providers financial incentives through potential bonuses or added payment to support higher-quality care; 57% put providers at financial risk for their performance if certain quality and costs goals are not met.
  • 6% of payments made to specialist are value-oriented.
  • 6% of payments made to primary care physicians are value-oriented.
  • Of total outpatient payments, 75% are made to specialists; 25% are made to primary care physicians.
  • 2% of commercial health plan members are attributed to a provider participating in a new model of care, such as an accountable care organization or patient-centered medical home.
  • 9% of hospital admissions are readmissions within 30 days of a discharge.

In an interview after the webinar, Delbanco stressed the importance of creating new payment methods in order to improve the cost and quality of care.

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