Infrastructure, policy seen as biggest barriers to value-based reimbursement

Infrastructure requirements and changing policy are the top barriers to speeding the adoption of value-based care, according to a survey of healthcare executives, clinical leaders and clinicians conducted by NEJM Catalyst.

The survey sought to offer insight into why—despite the long-cited refrain that healthcare is moving away from fee-for-service care—the uptake of value-based reimbursement remains low.

One of the issues, according to Paul Manner, MD, is there isn’t a universal definition of value-based care and stakeholders have trouble agreeing on what the components of value-based care mean.  

“A fundamental problem is that the interests of payers, patients, and providers do not coincide, except in the broadest sense,” Manner, with the University of Washington School of Medicine, told NEJM Catalyst. “We can all agree that patients should get the best possible outcome at the lowest cost, but we can’t even agree on how to define ‘cost,’ let alone ‘outcome.’ And that’s not going to change with a single-payer system, by the way.”

Among 552 respondents who were allowed to choose two answers, the most popular selections for what is hindering the implementation of value-based reimbursement were infrastructure requirements, including information technology (42 percent), and changing regulation/policy (34 percent). Administrative detail (33 percent), sustainability of savings (28 percent), data integration (20 percent) and patient engagement (18 percent) rounded out the list.

Notably, only 42 percent of respondents believed value-based reimbursement would ever be the primary revenue model in U.S. healthcare. Thirty-six percent said they were uncertain that would be the case and 22 percent said it wouldn’t be the case. Executives were more likely than clinical leaders and clinicians to believe value-based reimbursement would eventually rise to become the dominant model.

Read the full report below: