Report measures Virginia’s health-care payments

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Beth A. Bortz, president & CEO of Virginia Center for Health Innovation.
Photo by Rick DeBerry

A new study released Tuesday is designed to help Virginia measure success as it attempts to make health-care payments more value-oriented.

More than two-thirds, or 67 percent, of the health-care payments paid to doctors and hospitals in the commercial sector in 2016 contained incentives to improve both the cost and quality of care patients receive. For health-care payments made through Medicaid, 37 percent of them contained similar incentives that are considered value-oriented.

The findings were announced Tuesday morning by Catalyst for Payment Reform, the Virginia Center for Health Innovation and the Virginia Association of Health Plans. The numbers are part of The Virginia Scorecard on Payment Reform and are meant to act as a baseline in the state’s efforts to reform its health-care payments.

The payments highlighted in the report are considered to have some ties to value as opposed to just being based on costs and efficiencies. A payment tied to value is one that takes into consideration the quality and safety of the care being delivered and reduces unnecessary spending.
Virginia was one of three states picked by Catalyst for Payment Reform to have the study done. The study was part of a state pilot program called Virginia Scorecard 2.0. The study was funded by grants from the Robert Wood Johnson Foundation and the Laura and Arnold Foundation.

“This is our line to say here’s where we are,” says Beth A. Bortz, president and CEO of the Virginia Center for Health Innovation. “It looks like Virginia is taking a very positive step.”

The report is based on a survey of six Virginia health plans that together cover about 72 percent of privately insured patients in Virginia. The participating health plans were Aetna, Anthem, Optima, UnitedHealthcare, Cigna and Virginia Premier. The report also is based on a survey of four Medicaid managed care organizations who together cover about 58 percent of the Medicaid-insured people in Virginia.

In the United States, the health-care system is mostly based on a system where fees are paid for services. Doctors and hospitals are paid for how many services they offer. The result in the health-care industry can mean unnecessary fees and services that aren’t necessarily helping patients get better.

For years there have been efforts to move the health-care system toward a new model that rewards providers for positive outcomes for patients. The data released on Tuesday is an attempt to understand how Virginia is doing as it moves toward that model.

Tracking how Virginia progresses means continued study of payments tied to value, Bortz says. But it isn’t clear when another study will take place since there currently isn’t any funding for it.

“We can’t improve what we don’t measure,” Bortz says.

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