Knowing that taking risk on reimbursement is coming, they're hoping to build momentum by implementing population health strategies with their own employees, for example. They're also implementing their own narrow networks with local employers, in many cases.
But when it comes to negotiations with insurers, too often it's the same old game of negotiating fee-for-service contracts. Even the federal government, with its Medicare Shared Savings program and even the Pioneer program, seems to be moving faster.
Insurers, on the other hand, seem to want to slow-play the game of implementing risk on the facilities they pay, whether they be huge hospital systems or physician practices.
In some cases, these companies, which are presumably being pressured by employers to lower the rate of healthcare cost inflation, are making do with small, limited scope experiments in encouraging pay for performance and risk-based contracting. They're making a reasoned bet that they don't know enough about how risk sharing will pan out to implement it nationwide.
All healthcare is local, it's true, and what works in one geographical area won't necessarily work in another, but employers and patients are getting wise to how much healthcare costs them. They won't wait on insurers forever.