Home Health Care Providers are ready to shoulder more downside risk, survey shows

Providers are ready to shoulder more downside risk, survey shows


Healthcare providers have increasing appetite for risk in commercial payment and Medicare contracts, according to a new survey conducted by HFMA and Navigant.

The study asked 170 hospital and health system finance executives their thoughts and ambitions around risk assumption and found that 72 percent of executives both believe their organizations have the capabilities to support increased risk and plan to take on additional risk in the next one to three years.

A greater proportion of health system executives were more confident in their organization’s abilities to support a higher level of risk sharing than figures at standalone hospitals.

This also holds true across for executives launching or partnering on a provider-sponsored health plan and implementing new risk sharing models in the next few years.

Exactly what form that may take varies. The most popular risk-bearing strategy is commercial payer contracting models like bundled payments, which 64 percent of respondents said they were planning on implementing in the next three years.

Less popular were Medicare contracting models and Medicare Advantage, which saw 57 percent and 51 percent of respondents respectively planning to implement the models.

The leading rationale for respondents who said they were not looking to assume additional risk was a “lack of local market demand” with a lack of payer partnership opportunities and necessary infrastructure also ranking high.

Forty-four percent of respondents said they are already part of or plan to launch a provider-sponsored health plan. Among that group 57 percent said they were already part of a PSHP and 43 percent said they plan to launch one in the future, with the majority choosing a one to three year time frame.

“Sharing risk must be a collaborative pursuit between payers and providers,” Navigant Managing Director Kai Tsai said in a statement. “It’s clear that providers have built the capabilities needed to support enhanced levels of risk and are planning to increase their risk assumption in the near future. Both entities need to partner more closely to lessen the gap between the supply of and the demand for risk arrangements in markets nationwide.”

Preparation for new risk-bearing models were also a topic of the survey, with 62 percent respondents saying they have plans to increase investment in IT capabilities. That’s compared with 57 percent who pitched increasing investment in physicians engagement and 56 percent who said they were planning on growing their investment in member engagement areas.

The biggest challenge with maintain risk-based capabilities, were operational processes like contract execution and care coordination. This was followed by scale and reporting insights.

Navigant suggested a few key strategies to balance existing fee-for-service business models and growing within a new value-based system including engaging physicians to drive clinical standardization, working on cost reduction in specific areas like post-acute care and pharmacy and emphasizing capabilities to keep patients in-network.

“With most health systems anticipating continued downward pressure on margins, accepting risk can represent a lever for revenue growth, as long as providers clarify internal accountabilities and commit enough of their resources to risk models,” Richard Bajner, Navigant managing director and healthcare value transformation practice leader, said in a statement.

“The Affordable Care Act left many providers assuming that risk-based models would be the new normal, but the transition has not been as successful or widespread as anticipated,” Bajner added. The analysis found the market is still primarily driven by fee-for-service payments.

Picture: erhui1979, Getty Images

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