I can’t tell you how many times I’ve laden stories about value-based care with phrases like “if it ever comes” or “when the market is actually ready.” I’ve never been much of a capitation fan, and many of the VBC schemes I’ve reviewed look like capitation in new clothes, so maybe I’ve been engaging in wishful thinking.
In any event, the following study seems to be pushing hard to change my mind. In fact, new research from Change Healthcare notes that virtually every state in the US is planning VBC efforts, rolling out VBC programs or has already put such programs in place.
To conduct the study, Change did an analysis of publicly-available information including state and federal government resources, input from contractors participating in state-initiated VBC programs and information from healthcare industry analysts, think tanks, the policy research institutes and the media.
The researchers found that a whopping 48 states have implemented value-based care or payment programs, and that 50% of these programs involve multiple payers. This represents a seven-fold growth in the number of states and territories implementing value-based reimbursement, they reported.
The group of states includes six that have had value-based care strategies in place for four years or more, 34 with programs that have been in place for two or more years and eight states whose VBC efforts are at an early stage.
Along the way, 23 states have established value-based payment targets or mandates that both payers and providers agree to meet. Meanwhile, 22 states have adopted or are considering adoption of ACOs or ACO-like entities, and 16 states have adopted are considering adoption of programs focused on episodes of care.
Change rates three states (New York, Pennsylvania and Vermont) as being particularly progressive on the subject, with the plans notable for the broad sweep of their initiatives, use of shared risk-based payment models and willingness to test unusual strategies:
- New York, which got a demonstration waiver from CMS, tested a Medicaid-based pay-for-performance model which included risk-sharing arrangements with managed-care companies.
- Pennsylvania’s reforms have included multi-payer EOC payments for acute care and global payments for his primary care through patient-centered medical homes. It also required managed-care companies to achieve 30% of payments into APMs by this year.
- Vermont kicked off VBC efforts in 2011 when it initiated a patient-centered medical home strategy. It has also deployed other value-based payment strategies, including all-payer ACO model.
Whether or not my curmudgeonly perception of value-based programs is fair, I don’t seem to be the only one in favor of being a bit conservative here. Yes, a bunch of states are probably doing something VBC-flavored, but if what the top three players are doing is revolutionary, the rest can’t be up to much.
Not only that, while governments move slowly, things are dragging along at this point given the popularity of value-based approaches to healthcare price and quality reform. By my read of these statistics, value-based care is still at a much earlier stage than one might have thought given the hype.