Toward Accountable Payment

Survey results: Percentage of providers taking on risk doubled since 2011

Jordan Stone

We've already received over 110 responses from senior health care executives to our 2013 Accountable Payment Survey—an ongoing benchmarking initiative to demonstrate where our industry stands in the move toward payment reform, and where its leaders expect to go in the coming years.

While the group appears similar in size and composition to the 2011 participant pool, initial data suggests that attitudes toward risk have changed significantly.

A progressive respondent profile

As in 2011, many of this year's survey participants are responding for large, multi-hospital health systems, and most plan to experiment with accountable payment models soon, if they have not done so already.

As expected, almost all respondents still live in a world dominated by fundamentally volume-based payments. Around two-thirds of providers report generating more than 80% of their revenue from standard fee-for-service contracts (without quality or cost incentives), and about half are still receiving more than 90% of payments for patient care from such contracts.

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Significant uptick in total cost and bundled payment

And yet for many hospital executives, the important issue is not just where the industry is today, but also the trajectory toward more accountability for cost and quality.

According to our respondents, provider adoption levels for both bundled payment and total cost of care models (which include shared savings and capitated arrangements) rose substantially over the last two years. In 2011, the percentage of providers engaging either type of contract hovered around 15%. That rate has more than doubled for total cost of care contracts and grown by over 10 percentage points for bundled payments.

Accountable Payment Survey

In part, this shift reflects the introduction of a series of accountable care pilots developed by the Center for Medicare and Medicaid Innovation (CMMI) over the last few years—specifically, the Medicare Shared Savings Program (MSSP) and the Bundled Payments for Care Improvement (BPCI) initiative.

Meanwhile, the private sector is carving out a substantial accountable payment footprint as well: 65% of providers are contracting with commercial payers on new payment models, in many cases in conjunction with Medicare’s risk-based payment initiatives.

Our initial survey results suggest that trend toward greater provider accountability is not likely to abate. Of those still sitting on the sidelines, more than half anticipate engaging in total cost of care contracts within the next three years; two thirds expect the same to be true for bundled payments.

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