New CHIME Report Indicates Slow Movement to Alternative Payment Models
Although legislative pressure to transition to value-based care began several years ago, movement to alternative payment models (APMs) and changes to healthcare reimbursement have been slow, according to CHIME HealthCare’s Most Wired report.
The report, recently made public, was based on responses to CHIME’s 2019 Most Wired survey. CHIME (the College of Healthcare Information Management Executives) conducts the survey annually to assess how effectively healthcare organizations apply core and advanced technologies into their clinical and business programs to improve health and care in their communities. This year, CHIME offered an ambulatory survey in addition to a domestic and international hospital survey and introduced a performance excellence certification system using a Level 1 to 10 scale.
CHIME is a health IT association whose membership base includes a variety of C-suite health IT leaders, from CIOs to CMIOs, CNIOs, and others. This year’s report revealed an array of notable findings around key questions, such as how much progress the industry has made with population health management, including with the adoption of key technologies, like telehealth; how much risk hospitals are taking on as they shift to value-based care; and how security programs have evolved amid ever-increasing security threats.
Indeed, the data showed, fee-for-service continues to be the dominant payment model, with alternative payments accounting for 26 percent of Most Wired participants’ revenue. There was a modest increase in the adoption of most financial tools between 2018 and 2019, but two in particular—real-time identification/tracking of value-based care conditions and distribution/management of bundled payments—saw upticks of 11 percentage points and 8 percentage points, respectively.
Most organizations do use a mix of payment models, but 93 percent of participating organizations still use fee-for-service in some way; most of the remaining 7 percent rely on other revenue streams, like government payments or donations. “Fee-for-service is unlikely to be eliminated entirely, but value-based payment models will likely continue to expand to comprise more of organizations’ revenue streams,” the report’s authors noted.
Recently, the Health Care Payment Learning & Action Network released data that revealed fairly similar results, publicizing statistics showing that 35.8 percent of total U.S. healthcare payments were tied to APMs in 2018. Fee-for-service payments have dropped 33 percent since 2015, that study showed.
Pop health progress?
What’s more, the report indicated that healthcare organizations are making headway with their population health management efforts. On average, 81 percent of respondents have adopted basic tools for care management although the adoption of advanced technologies is much lower; for example, 40 percent of participating organizations have adopted a full CRM solution and 46 percent have tailored advanced analytics.
More than 80 percent use their EHR for various population health activities, and 63 percent include third-party tools. Those that use the EHR plus third-party tools, but no manual tools, report a stronger impact on patient, clinician, operational and financial outcomes.
As it relates to patient engagement, almost all respondents offer patient portals that include clinical information like test results and visit summaries, and about half include functionality like self-management tools for chronic conditions. The more patients used the portals, the greater was the impact on outcomes. Telehealth remains a challenge, though; two-thirds of organizations with telehealth services reported less than 10 percent of patients have used them.
Meanwhile, almost all participants have made the EHR and imaging data remotely accessible to clinicians yet less than half allow remote access to alerts and notifications for patients with chronic conditions. Most organizations have integrated at least one measured type of patient-monitoring data source, and those that integrate at least seven reported a 10 percent higher impact on outcomes. More organizations reported the ability to consume CCD data into their EHR as discrete data in 2019 compared with 2018. The ability to consume data from skilled nursing facilities and home health agencies also improved, but about one-third still lack that ability.
Interestingly, the ambulatory results mostly mirrored trends seen with acute-care organizations but there were a few differences, too. Compared with acute-care organizations, ambulatory facilities were slightly more likely to have adopted a mix of population health technologies and had higher adoption of portal functionalities overall. They also were more likely to offer telehealth services but patient use was low in this setting as well. More ambulatory facilities reported that their patient engagement tools had a high impact on outcomes.
Room for cybersecurity improvement
From a cybersecurity perspective, results are mixed in terms of just how much progress has been made in organizations’ sophistication levels and how well they’re prepared. On one hand, most organizations reported that they employ some components of a comprehensive security program, but only about one third have adopted all 11 core components of a comprehensive security program, as outlined by CHIME. Nine of 10 organizations that do have a comprehensive security program and high adoption of security measures report a high positive overall impact.
A separate survey of CHIME members, conducted by managed security services provider Proficio, revealed that despite respondents saying the number of cyberattacks are increasing, over 80 percent of CIOs rated the security posture of their organization 3 out of 5 or less, suggesting room for improvement in defending against cyberattacks.
Additionally, nearly half the CIOs surveyed agreed that having access to an executive dashboard that highlighted gaps in their security controls and compared their organization to peers would be valuable, indicating a need for increased visibility and better tools to help CIOs understand and improve their security posture.
Ransomware continues to be a top concern, with healthcare organizations being one of the biggest targets. The threat of cybercriminals stealing medical records was the next most important concern, followed by the risks from data and applications being transferred to the cloud without adequate security, according to that survey.
