Value-Based Reimbursement Statistics 2024 – Everything You Need to Know

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Are you looking to add Value-Based Reimbursement to your arsenal of tools? Maybe for your business or personal use only, whatever it is – it’s always a good idea to know more about the most important Value-Based Reimbursement statistics of 2024.

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Best Value-Based Reimbursement Statistics

☰ Use “CTRL+F” to quickly find statistics. There are total 154 Value-Based Reimbursement Statistics on this page 🙂

Value-Based Reimbursement Benefits Statistics

  • The survey finds that 31 percent of large employers offering health benefits have a financial incentive for employees to complete health risk assessments, and 28 percent have an incentive for employees to complete biometric screening. [0]

Value-Based Reimbursement Usage Statistics

  • The usage rate per thousand among valuebased members over nonvalue based members hovered between 5% and 10% each month between May and December. [1]
  • Preventative care lowered the usage of acute care services, and valuebased physicians reduced avoidable hospitalizations by 11% over their feefor. [1]

Value-Based Reimbursement Adoption Statistics

  • Medicaid also saw some progress with valuebased reimbursement adoption, increasing the proportion of payments from two sided risk models from 10.6 percent in 2019 to 14.5 percent in 2020. [2]

Value-Based Reimbursement Latest Statistics

  • The 2020s require a new strategy that moves from a shortterm focus on testing new payment models to a long term focus on expanding models that are most likely to generate substantial savings and improve quality. [3]
  • Beyond committing to tying 90% of traditional Medicare feefor service payments to quality, CMS also sought to have at least half of payments flowing through APMs by 2018. [3]
  • In 2018, feefor service with no link to quality or value still accounted for nearly 40% of all insurer payments, and the majority of payments in Medicaid and commercial insurance. [3]
  • In 2020, roughly 500 MSSP ACOs served over 11 million Medicare beneficiaries (about 20% of all enrollees). [3]
  • While patients in ACOs tend to have a higher clinical risk, providers in communities serving populations with social risk factors are less likely to participate in ACOs.5, 6. [3]
  • In the first performance year of BPCI Advanced , 22% of eligible hospitals and 23% of eligible clinicians participated in the program, which paid for 16% of potential episodes. [3]
  • BPCI Advanced hospitals were more likely to be urban, larger, and non. [3]
  • In 2020, 37% of Medicare MSSP ACOs took on downside risk, up from less than 10% in 2017.9,10. [3]
  • In 2021, 41% of MSSP ACOs appear to be taking on downside risk, but the number of program participants and attributed beneficiaries has. [3]
  • In 2020 Premiums In Employer Sponsored Plans Grow 4 Percent; Employers Consider Responses To Pandemic. [3]
  • Most healthcare payments made in 2020 were tied in some way to value or quality of care, according to the latest data from the Health Care Payment Learning & Action Network. [2]
  • The LAN’s latest APM Measurement report showed that 40.9 percent of US healthcare payments, representing approximately 238.8 million Americans and over 80 percent of the covered population, stemmed from value based reimbursement models last year. [2]
  • Additionally, almost a fifth of all healthcare payments made last year were in some way tied to value or quality of care while still being based in feefor. [2]
  • The remaining 39.3 percent of payments were strictly feefor. [2]
  • In 2020, just 15.0 percent of traditional Medicare and 38.0 percent of Medicare Advantage payments were strictly feefor. [2]
  • Both of those percentages are also down from 2019’s data, which showed 14.1 percent of traditional Medicare and 46.0 percent of Medicare Advantage payments being strictly feefor. [2]
  • In traditional Medicare, 24.2 percent of payments were part of some two sided risk model compared to 20.2 percent in 2019. [2]
  • In Medicare Advantage, the percentage of payments in two sided risk models increased from 28.6 percent in 2019 to 29.3 percent in 2020. [2]
  • This was despite a slight increase in feefor service payments, which represented 59.0 percent of Medicaid payments last year. [2]
  • Private payers covered 62 percent of the lives represented in the LAN’s data, yet over half of payments made by the payers in 2020 were from feeforservice and just 10.8 percent were from two. [2]
  • Additionally, more payments made to providers by private payers were tied to two sided risk models in 2019. [2]
  • The report shows that 53.5 percent of payments were from feefor. [2]
  • A survey of payers participating in the report showed that 87 percent think alternative payment model activity will increase; none said it would decrease. [2]
  • According to LAN’s data, approximately 39 percent of healthcare payments made in 2018 were under feefor. [4]
  • Another 25 percent were feefor service with some link to quality and/or value. [4]
  • According to the federal agency, the Medicare Shared Savings Program, which currently governs 517 accountable care organizations , has actually increased Medicare spending. [4]
  • Only about 5 percent of healthcare payments made in 2018 flowed through one of these models, LAN reported. [4]
  • Advocate Aurora Health also partners with a platform called NowPow to address the social determinants of health, which can impact between 10 and 20 percent of outcomes. [4]
  • ValueBased Reimbursements Hit 53% in 2017, Reform Slows Over half of payments made to providers in 2017 were value based reimbursements, but payment reform overall is slowing down. [5]
  • In 2012, 10.9 percent of payment channeled through a value based reimbursement system and 2013 saw that percentage nearly triple. [5]
  • By 2016, 48.5 percent of payments were coming to providers through a value. [5]
  • The percentage of patient population in valuebased care in 2016 was over ten times the percentage in 2012, rising from 2 percent to 24 percent over the four. [5]
  • However, in 2016 and 2017 payment reform decelerated, with less than five percent growth. [5]
  • Furthermore, 90 percent of valuebased reimbursements in 2017 were still grounded in feefor. [5]
  • And there has been little change in the prevalence of providers taking on downside risk in value based arrangements, with only 6 percent of respondents saying they engaged in downside risk in 2017. [5]
  • The scorecard’s previous five years saw a shift from payfor performance to shared savings payment arrangements, with shared savings payment arrangements as a percent of the total payment to providers rising six percentage points from 2016 to 2017 alone. [5]
  • Meanwhile, participation in bundled payments was steady and only saw a 0.4 percent difference in the first and last studies, rising from 1.6 percent in 2012 to 2.0 percent in 2017. [5]
  • 2013 scorecard noted that 7.45 percent of commercially insured patients cited affordability as a barrier to care. [5]
  • In 2016, that percentage rose by two percentage points and in 2017 it kept rising. [5]
  • The results show a two percent increase in payers offering or supporting a cost calculator between 2013 and 2018. [5]
  • BCBSAZ Shared Savings Program Reduces Hospital Readmissions by 26% “Given the growing recognition that high prices are the major reason health care costs continue to rise while the use of services remains flat. [5]
  • The researchers found that a patient with diabetes was more likely to get an HbA1c test in 2012 than in 2017, with 88.7 percent getting the blood sugar measurement in 2012 and 87 percent in 2017. [5]
  • The number of patients who receive home recovery direction from their provider went up by two percentage points between 2012 and 2017. [5]
  • Just as in 2012, around 8 percent of patients are readmitted to the hospital within 30 days of initial discharge during the 2017 study period. [5]
  • Two percent more providers advised parents to get their children vaccinated in 2012 than in 2017. [5]
  • In 2020, as in 2018, almost all physicians (97%). [6]
  • The proportion of physicians (23%). [6]
  • Almost half (48%). [6]
  • Just under half (46%). [6]
  • For instance Physicians estimate significant portions of their work today can be performed by nonphysicians (30%) in nontraditional settings (30%). [6]
  • According to the Medical Group Management Association, in late April 2020, 97% of medical practices experienced a negative financial impact directly or indirectly related to COVID. [6]
  • This included a 60% decrease in patient volume and a 55% decrease in revenue, forcing many practices to furlough or lay off staff. [6]
  • We see parallels in the public sector Seventyone percent of 2019 Medicare Shared Savings Program participants were in upside. [6]
  • Traditional sources (97%) continue to be the predominant way physicians are paid, whereas value based payments (36%). [6]
  • Our client experience echoes these findings Compensation models inherited from the 1990s remain common, such as work relative value units, number of admissions or shifts, revenue minus practice expenses, or percentage of collections or gross charges billed. [6]
  • And even though we see some fluctuations, the proportion of physicians who receive meaningful bonuses of more than 5%, has remained largely unchanged, about one in four. [6]
  • In 2020, the majority (77%) either received small performance bonuses of up to 5% (39%) or were not eligible for bonuses altogether (39%). [6]
  • Physicians’ tolerance for risk is greater than their typical bonus in the 10%–15% range. [6]
  • At the same time, physicians have told us that they are willing to accept more risk than their typical bonus today They would accept between 10% and 15% of total compensation tied to quality and cost. [6]
  • Only 51% are aware of the costs and treatments they select, and 48% are comfortable discussing costs with patients. [6]
  • And even though 73% of physicians say they try to incorporate nonclinical considerations around social determinants of health into their decision making, foundational information to help address social determinants is hard to come by. [6]
  • Fewer than half (46%) of our respondents have access to economic and community profile data of the patients their practice serves through either the electronic health record (25%), a portal (12%), or paper or fax (10%). [6]
  • Designed to bring the evidence base to the practice and reduce variation in care, clinical pathways were available to 77% of physicians in 2016. [6]
  • Yet, four years later, less than half (46%). [6]
  • We repeated a question we asked six years ago and saw a large increase in the proportion of physicians who say they have a prominent role in limiting the use of unnecessary treatments and tests 76% in 2020 vs. 57% in 2014. [6]
  • They estimate that even today, sizable portions of their work can be performed by nonphysicians (30%) in nontraditional settings (30%). [6]
  • and/or can be automated (18%). [6]
  • One in two physicians expects a great deal of change in their specialty (50%) in the next 10 years, particularly primary care practitioners (61%). [6]
  • The top three issues they want medical education to address are Business and economics of medicine (65%) Prevention and sustaining well being, such as nutrition or social determinants of health (59%) Development of teamwork skills (45%). [6]
  • Between 2014 and 2020, there was a 19 percentage point increase in the proportion of physicians who say they have a prominent role in limiting the use of unnecessary treatments and tests. [6]
  • The physician network and financial viability are top business concerns (both at 47%). [6]
  • In 2011, the average hospital margin on Medicare patients was. [7]
  • The researchers saw smaller growth in average annual medical spending on claims for the Blue Cross Blue Shield members than for those in other states, with savings deepening over time, up to 12%. [8]
  • More than 80% of Massachusetts physicians and hospitals currently take part in the AQC model. [8]
  • More than 70% of VBAs implemented between 2014 and 2017 were not publicly disclosed. [9]
  • The shift towards value based payment has only accelerated in January 2015 the U.S. Department of Health and Human Services announced their intent to tie 85% of all traditional Medicare payments to quality or value by 2016 and 90% of payments by 2018. [10]
  • From 2004 to 2013, the IHA awarded a total of nearly $500 million in bonus payments; however, to put these rewards in context, the total incentive payments in 2007 was $52 million, which represented only about 2% of total base compensation. [10]
  • The average state performance was below 75th percentile on national benchmarks for Health Effectiveness Data and Information Set measures while the top quartile of physician groups scored comparable to the 90th percentile. [10]
  • State performance improved an average of 3% annually in overall clinical quality, with improvements in individual measures ranging from 5.1% to 12.4%. [10]
  • For providers, substantial amounts of Medicare payments will be in play, with positive or negative adjustments up to 4% in 2019 and increasing over time to up to 9% in 2024. [10]
  • 21Exceptional performers may qualify for an additional 10% positive adjustment annually. [10]
  • Exceptional performers may qualify for an additional 10% positive adjustment annually. [10]
  • Premier HQID hospitals could receive either a one to two percent bonus or, starting in 2006, penalty adjustments, based on performance on 33 measures. [10]
  • Initially, hospitals were eligible if they achieved the top 20th percentile on metrics, but, in the fourth year, the program introduced bonuses to hospitals with substantial improvements in performance. [10]
  • Adjusting for baseline performance and characteristics, a range of 2.6% to 4.1% improvement over the study period was attributed to payfor. [10]
  • While the study results are limited by lacking a robust control group, process measures improved and hospital acquired conditions decreased by over 15% over two years, or an estimated cost savings of $110.9 million. [10]
  • Performance is scored based both on attaining a certain achievement level and on improvement compared to each hospital’s baseline and benchmark.32,33,34In 2016, the HVBP program increased to representing 1.75% of all Medicare payments to hospitals. [10]
  • In practical application, hospitals will all have 1.75% of all payments withheld, that they can then earn back depending on their Total Performance Score. [10]
  • Some hospitals will earn less than the 1.75% back and have a “penalty,” and some hospitals will earn more than the 1.75% back and have a “bonus.”. [10]
  • In 2016, about half of hospitals will see a minimal change in the Medicare payments, with the overall adjustment being between −0.4% and +0.4%. [10]
  • The worst performing hospital will earn back none of the 1.75% withhold, and the highest performing hospital will have a net increase of approximately 1.25%. [10]
  • The review found that the typical incentive was less than 5% of total provider income, with the exception of the U.K. and Turkey programs where general practitioner practices had the potential to increase compensation by almost 25% and 20% respectively. [10]
  • Analysis of early results showed risk adjusted mortality for all conditions decreased and the VBP was associated with a 1.3% reduction in combined mortality. [10]
  • The Commonwealth Fund surveyed state Medicaid programs to determine the prevalence of VBP programs and found that, as of 2006, more than half of all state Medicaid programs had at least one existing VBP program and more than 70% had plans for new programs. [10]
  • In 2016, the HVBP program increased to representing 1.75% of all Medicare payments to hospitals. [10]
  • We obtained responses from 1,534 (35.14%). [11]
  • The findings were published in Humana’s annual valuebased care report, which also found that 67% of its individual MA members seek care from primary care physicians in value. [1]
  • Drilling down further into the numbers reveals that the vast majority of Humana MA members – almost 90% – have at least one chronic condition, while about 83% have at least two chronic conditions. [1]
  • Despite the trend during the COVID19 pandemic of deferring care, 86% of the insurer’s MA members still saw their valuebased primary care physicians at least once last year, compared to 78% among those in nonvalue. [1]
  • This consistency, the numbers showed, reduced incidences of hospital admissions and emergency room visits during 2020 for valuebased members – 7% and 12% lower, respectively – compared to those with nonvalue. [1]
  • Hospitalization avoidance fared even better – it was a whopping 22% less – when measured against original Medicare. [1]
  • MA members affiliated with value based physicians took part in nearly 628,000 behavioral visits, representing roughly 21% of all telehealth visits in 2020. [1]
  • MA members affiliated with value based physicians and receiving home health services had a 60% lower risk of readmission to a hospital within 30 days of discharge and a 45% lower readmission risk within 60 days, the numbers showed. [1]
  • And care of those members resulted in an 11% lower total 90 day healthcare cost, including costs associated with home healthcare. [1]
  • That, in turn, led to an estimated medical cost savings of 13.4% compared to original Medicare. [1]
  • That percentage amounts to a $3.1 billion reduction in medical costs that would have been incurred by value based members during 2020 had they been enrolled in original Medicare, Humana found. [1]
  • The move will increase its geographic presence by nearly 30%. [1]
  • In all, this represents a 26% expansion of Centene’s MA footprint, with the offering available to a potential 48 million beneficiaries across 36 states. [1]
  • Moreover, since low back pain is estimated to affect 80–85% of the world’s population [7] with a large and growing economic burden [8], a well functioning reimbursement program within spine surgery is important. [12]
  • This is most likely due to the fact that it has proven difficult to summarize and synthesize actual effect on quality due to substantial heterogeneity in the types of outcomes [12]. [12]
  • One year after surgery, the expected P4P is adjusted according to the actual patient reported outcome of GA. [12]
  • Patients who turned out better than predicted generated a positive adjustment, in the range of 1 to 6% of the prospective payment. [12]
  • Whereas patients that turned out worse than predicted generated a negative adjustment, in the range of − 1 to − 18% of the prospective payment. [12]
  • The total possible score is 50 and a standardized formula is used to transform the score to a percentage score of disability, where 0% corresponds to no disability and 100% corresponds to full disability. [12]
  • Statistical significance was assessed at the 5% level. [12]
  • Further, the proportion of patients with at least one registered comorbidity increased from 15% to 19%. [12]
  • The ODI level however, decreased with 0.7 percentage points, indicating a less impaired population. [12]
  • The proportion of patients being employed increased from 53% to 55% and patients born outside of Europe increased from 8% to 12%. [12]
  • Both before and after the introduction of VBRP, 71% of the patients answered GA. [12]
  • corresponded to 78%, both before and after the introduction of the new reimbursement program. [12]
  • Further, the fraction of patients that did not have pain before the surgery remained at 5% after the introduction. [12]
  • The disability level prior to surgery among patients surgically treated in 2006 was 42.68%. [12]
  • The disability level at 1year follow up among patients surgically treated in 2006 was 22.14% and there was no change in level or trend at the introduction of the STHLM. [12]
  • The relative improvement in disability level among patients surgically treated in 2006 corresponded to a 20.61 percentage point decrease. [12]
  • [42] have showed that larger improvements in quality is likely to occur during the second year when implementing a VBRP. [12]
  • New ICD10 version of the Charlson comorbidity index predicted in. [12]
  • We obtained responses from 1,534 (35.14%). [13]
  • Experiencing autonomy supportive mentors during a clinical rotation in medical school makes trainee physicians more likely to choose that specialty.[54]. [13]
  • Completed questionnaires were received from 1,534 with 689 (45%) from California, 554 (39%) from MHQP, and 291 (51%). [13]
  • One rule of thumb is that extracted factors should collectively account for more than 60% of the total variance.[81]. [13]
  • Itemlevel goodnessoffit in the GRM was assessed using the generalized S Σ2 index,[87] evaluated at the 1% significance level due to the short length of the scales.[88]. [13]
  • We evaluated the ESEM/CFA models’ goodness of fit using the comparative fit index , Tucker Lewis Index , and the root mean square error of approximation with its 90% confidence interval.[96. [13]
  • (90% CI = .109 –.150), p < .001. [13]
  • 2values for single factor ESEM and CFA models estimated on the validation subset. [13]
  • , representing a shared variance of 89.68%. [13]
  • We observed 89.79% agreement between PPAS6 and PPAS 3 scales in discriminating high autonomy support. [13]
  • Continuous scores on the PPAS3 scale predicted high autonomy support on the PPAS 6 scale when assessed by a generalized univariate logistic regression =. [13]
  • 189.46, p < .001; odds ratio 39.730 (95% CI 23.499–67.172). [13]
  • In another generalized univariate logistic regression, high scores on the PPAS3 scale strongly predicted high scores on the PPAS 6 scale . [13]
  • 257.37, p < .001; odds ratio 53.292 (95% CI 32.731–86.769). [13]
  • Ability of high scores on the shorter scale to distinguish high autonomy support on the full length scale is also evidenced by a sensitivity of 93.99%, specificity of 77.30%, positive predictive value of 81.08%, and negative predictive value of 92.56%. [13]
  • Withinsubgroup coefficients of variation in PPAS6 scale scores generally fell between 22 and 27%, and those for PPAS 3 scale scores were between 24 and 30%. [13]
  • This suggests that the proportion of variability in scale scores related to subgroup membership was minimal–ranging from 0.1% to 1.23% for PPAS6, and 0.1% to 0.75% for PPAS. [13]
  • according to both the R statistic and ttest, such correlations at the between subgroup level were not significant. [13]
  • Competing priorities and regulatory uncertainty are making it difficult for health care organizations to transition from feeforservice to feeforvalue, according to a new report released in mid. [0]
  • Among these firms, 15 percent offer a maximum incentive greater than $1,000 for all of a firm’s health and wellness programs, including any incentives for health screening. [0]
  • Sustainability of savings is the greatest challenge facing valuebased reimbursement models, according to the 2015 Healthcare Benchmarks Value. [0]
  • According to the Center for Health Value Innovation, 90 percent of employees participated in the HRA, and Caterpillar attained a 50 percent reduction in disability days after implementing the program. [0]
  • Marriott was facing yearly costs of more than $400 million to cover 160,000 people, with costs rising about 7 percent a year. [0]
  • It is widely known and accepted that five percent of the population consumes about 50 percent of the health dollar in the Unitd States. [0]

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Reference

  1. ncsl – https://www.ncsl.org/research/health/value-based-insurance-design.aspx.
  2. healthcarefinancenews – https://www.healthcarefinancenews.com/news/value-based-contracts-led-better-care-quality-says-humana.
  3. revcycleintelligence – https://revcycleintelligence.com/features/the-state-of-value-based-reimbursement-financial-risk-in-healthcare.
  4. upenn – https://ldi.upenn.edu/our-work/research-updates/the-future-of-value-based-payment-a-road-map-to-2030/.
  5. revcycleintelligence – https://revcycleintelligence.com/features/entering-the-next-phase-of-value-based-care-payment-reform.
  6. healthpayerintelligence – https://healthpayerintelligence.com/news/value-based-reimbursements-hit-53-in-2017-reform-slows.
  7. deloitte – https://www2.deloitte.com/us/en/insights/industry/health-care/physicians-guide-value-based-care-trends.html.
  8. healthcatalyst – https://www.healthcatalyst.com/insights/hospital-transitioning-fee-for-service-value-based-reimbursements/.
  9. statnews – https://www.statnews.com/2019/07/24/value-based-care-works/.
  10. nih – https://pubmed.ncbi.nlm.nih.gov/30763037/.
  11. nih – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378385/.
  12. nih – https://pubmed.ncbi.nlm.nih.gov/32236139/.
  13. biomedcentral – https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05578-8.
  14. plos – https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230907.

How Useful is Value Based Reimbursement

On the surface, the concept of value-based reimbursement makes sense. By shifting the focus from quantity to quality of care, it is intended to incentivize healthcare providers to deliver more efficient and effective care to their patients. This, in turn, is supposed to result in better outcomes for patients, lower costs for payers, and improved overall health system performance.

However, the reality is often much more complex than the theory. While value-based reimbursement has the potential to improve patient care and lower costs, the implementation of this payment model can be fraught with challenges.

One of the main criticisms of value-based reimbursement is the difficulty of measuring “value” in healthcare. The concept of value can vary greatly depending on the perspective – patients, providers, payers, and policymakers may all have different ideas of what constitutes value in healthcare. This can make it challenging to develop standardized metrics that accurately capture the quality and cost of care.

Additionally, the shift to value-based reimbursement requires healthcare providers to invest in new technologies, processes, and infrastructure to track and report on quality indicators. This can be a significant burden, especially for smaller practices with limited resources. Without adequate support and resources, providers may struggle to implement and sustain value-based care models, leading to potential disparities in care quality and outcomes.

Another challenge with value-based reimbursement is the potential for unintended consequences. In some cases, providers may be incentivized to avoid treatments or services that could benefit patients but are not reflected in quality metrics. This could result in underutilization of services or rationing of care, which could harm patients in the long run.

Moreover, the transition to value-based reimbursement can be disruptive to the traditional fee-for-service payment model, which has been the dominant payment mechanism in healthcare for many years. Providers may face financial risks and uncertainties during the transition period, which could impact their ability to deliver high-quality care.

Despite these challenges, there are also potential benefits of value-based reimbursement. By aligning financial incentives with quality of care, providers may be motivated to adopt evidence-based practices, improve care coordination, and focus on prevention and population health management. This could lead to better patient outcomes, reduced costs, and overall improvement in health system performance.

In conclusion, value-based reimbursement has the potential to drive positive changes in the healthcare system by incentivizing quality and efficiency of care. However, the implementation of this payment model is not without challenges, and careful consideration must be given to the design and execution of value-based reimbursement programs to ensure that they achieve their intended goals without compromising patient care or provider viability.

In Conclusion

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