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Doctors Feel Pressure to Accept Risk-based Reimbursement

Jacqueline Fellows, for HealthLeaders Media, July 24, 2014

Already this year, UnitedHealthcare announced that $27 billion of its annual reimbursements to physicians and hospitals are tied to accountable care and performance-based programs. By 2018, UnitedHealthcare is hoping to increase that to $65 billion.

Independence Blue Cross, which is in 24 states and Washington D.C., reports that nearly 90% of the providers in its ACO payment model lowered readmission rates by an average of 16%.

Lefkowitz attributes the high rate of adoption at his practice to HealthCare Partners Nevada's long history of managing care with an eye toward value rather than fee-for-service. In fact, in 2006, the group terminated all 12 of its FFS contracts and went to a 100% global risk arrangement. They were working exclusively with a Medicare Advantage payer.

"It was a very difficult decision to make, but at the time we realized the way the organization was structured, in terms of providing more resources in our clinics, we were not able to effectively provide the same care that we would in a value-based arrangement," he says.

The practice stayed at risk for three years before acquiring a primary care practice that was mostly FFS. It swung them back into what is more likely a truer reality for other practices across the country: practicing medicine two payment models.

"It was our goal not to displace patients," he says. "And while 50% of our patients are in FFS arrangements, over 80% of our revenue comes from value-based reimbursement. I don't know if it's realistic to think 100% of the reimbursement will be value-based."


Jacqueline Fellows is an editor for HealthLeaders Media.
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