Hospitals and Health Systems Prepared to Increase Risk Assumption, Analysis Suggests
Navigant survey conducted by HFMA shows providers planning to advance
According to the survey of 170 hospital and health system senior finance executives, 72% both believe their organizations have the capabilities needed to support increased levels of risk and plan to take on additional risk in the next one to three years across the following:
- Commercial payer contracting models: 64%
Medicarevalue-based models: 57% Medicare Advantage: 51%
Survey results also show providers are partnering on or launching provider-sponsored health plans (PSHPs) as a part of their risk-assumption strategy. Forty-four percent of respondents say their organizations are already part of a PSHP (25%) or plan to launch one in the future (19%).
“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,” said
Market trends impacting provider margins include the addition of
approximately 10,000 people to
“Sharing risk must be a collaborative pursuit between payers and
Having the appropriate technology underpinning is essential to payer-provider risk arrangements. When asked in what areas they’re planning to increase investments (financial, labor) to enhance collaboration with payers and support increasing levels of risk, 62% of respondents suggested technological capabilities with more than half citing physician (57%) and member (56%) engagement.
Among executives suggesting their organizations will not pursue increased risk levels, 56% cited a lack of local market demand. In addition, 42% of executives suggested operational processes, such as contract execution and care coordination and management, as the top challenge with maintaining risk-based capabilities.
Even with their increased risk-assumption interest, providers will inevitably continue to operate in a market primarily driven by fee-for-service (FFS) payments. But the path forward does not have to be an either-or scenario. Hospitals and health systems can drive revenue and margin growth in both FFS and value-based worlds through strategies focused on engaging physicians on clinical standardization, targeted cost of care reductions in areas such as post-acute care, and building tight provider network relationships, the analysis suggests.
View full survey results at www.navigant.com/RiskReadiness.
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