For well over a decade, Medicare Advantage plans and other payers have experimented with value-based payment models to reward physicians and hospitals for delivering efficient, high-quality care. Although the movement of provider reimbursement away from fee-for-service towards value-based care has been slower than expected, progress can be accelerated with advanced data analytic platforms and enriched health plan member data.

A recent University of Pennsylvania white paper shows that adoption of value-based and alternative payment models (APMs) has been uneven across providers and geographic areas. 2021 data published by the Health Care Payment and Learning Network shows that 19.6% that of U.S. health care payments flowed through advanced payments models. Unfortunately, many payment models do not use social determinants of health (SDOH) measures.

When one considers that more that 70% of health outcomes are driven by SDOH, the impact of value-based care delivery can be further amplified by ensuring relevant SDOH measures are incorporated into next generation value-based payment (NGVBP) models. While many providers support SDOH screening in clinical settings, less than 25% currently screen for social needs. There is clearly an opportunity to increase:

The following table highlights how innovative clinical data integrators like Health Chain can increase NGVBP model adoption and help providers improve patient outcomes.

Although increasing adoption of next generation value-based payment models appears challenging, it can be achieved. To learn more about how these obstacles can be overcome to benefit all healthcare stakeholders, contact us.