Dive into the latest research study from Availity, and learn more about provider attitudes toward value-based payment models. Get an overview of current-state physician reimbursement, find out current and expected adoption levels, learn administrative and operational challenges that are barriers to further adoption, and discover physician attitudes toward outcomes and cost savings.

1. PROVIDER ATTITUDES
TOWARD VALUE-
BASED PAYMENTS
An Availity research study

2. WHAT’S INSIDE
A little bit about Availity
The health care reimbursement landscape
What we learned:
 Current and expected adoption levels
 Administrative and operational challenges
 Attitudes toward outcomes and cost savings

3. FIRST, A QUICK
NOTE ON WHY WE
DO WHAT WE DO.

4. — Physician News Digest
The physician billing cycle
is one of the most, if not
THE MOST
COMPLICATED
REVENUE CYCLE
in American business today.

5. WE CAN HELP.
Availity simplifies the business of
health care with tools that help you
get paid faster, with fewer
headaches.

6. We help you build a
healthier business
with better tools:
 A free Web Portal
 An all-payer Advanced
Clearinghouse
 A powerful Revenue Cycle
Management suite
 A smarter Patient Access
solution
6

7. WE’VE HELPED A LOT OF PEOPLE

8. PUBLISHED
RESEARCH
Because you need trusted, timely information
to develop strategic plans that advance your
business, Availity conducts and publishes
research on key issues at the intersection of
health care and technology.

9. NOW THAT WE’RE
ACQUAINTED…

10. THE
REIMBURSEMENT
LANDSCAPE

11. 11
REIMBURSEMENT IS CHANGING
Most providers participate in
at least one value-based
payment model.
• 360+ Medicare ACOs1
• 207 private ACOs2
• + other VBP programs:
patient-centered medical
home, pay-for-performance
and payment-for-
coordination.
Meanwhile, revenue is at risk
from other market shifts.
• Patient payments are
increasing through high-
deductible plan membership
growth
• Health insurance exchange
business is up.
1 The Brookings Institution web site, Year One Results from Medicare Shared Savings Program: What it Means Going Forward, February 7, 2014
2 Leavitt Partners, Geographic Distribution of ACO Covered Lives, December 2013

12. 12
PROVIDER IMPACT
Provider challenges:
• Increased operational and
administrative complexities
• Managing alongside fee-for-
service models
• Workflow integration
Downstream effects:
• Operational uncertainty
• Inability to accurately forecast
revenue
• Sustainable and efficient
growth in value-based
payment models may be
hindered

13. 13
Earlier Availity
research revealed
what was necessary
for value-based
models to work
1. Limit or eliminate
labor-intensive
processes.
2. Automation is
key

14. 14
WHAT’S THE EXPERIENCE NOW?
Availity wanted to gauge current provider
experiences, attitudes and concerns
regarding value-based payments.
That required us to understand:
• Revenue sources and experience
• Adoption and growth trends
• Attitudes toward value-based payment models
• Challenges and barriers to adoption

15. 15
SO WE ASKED HEALTH CARE
PROFESSIONALS
Web-based
surveys were
completed by a
representative
sample
324 practice-based
professionals
• Primary care providers
• Specialists
216 facility-based
professionals
• Mix of hospital and
system sizes

16. THE RESEARCH

17. KEY FINDING #1
Provider engagement in value-
based payments exceeds
growth expectations, increasing
the already high pressure on
operations and staff.

18. GROWTH EXCEEDS EXPECTATIONS
75%
of providers
participate in one or
more value-based
payment model
25%
agree that value-
based payment
models make it easy
to understand, track
and project revenue
80%
say they need
additional staff and
time to manage
value-based
payment models
18

19. KEY FINDING #2
Attitudes toward value-based
payment models are mixed,
reflecting uncertainties and
provider concerns.

20. UNCERTAINTIES AND CONCERNS
30%
of providers believe
that value-based
payments offer enough
reward for the risk
50%
agree that value-
based payment
models will
positively affect
health outcomes
and cost
20

21. KEY FINDING #3
Despite the uncertainties, and
while value-based payments
represent only a small percentage
of current revenue, providers
anticipate strong growth.

22. 20%
of provider revenue
currently comes from
value-based models
60%
believe value-
based payments of
some type will
become the
dominant model
SIGNIFICANT GROWTH IS EXPECTED
OVER THE NEXT 3 YEARS
22

23. KEY FINDING #4
Sustainable growth requires a
focus on—and resolution of—
data concerns, staff acceptance
issues and operational
integration problems.

24. LOOKING AHEAD
60%
of providers believe
value-based
payments will become
the dominant model
75% +
of physician practices and
hospitals agree that real-time
information sharing will be
critical for success
24

25. ADDITIONAL
HIGHLIGHTS:
CHALLENGES
AND ATTITUDES

26. The complexity of administering
these plans is likely to be costly.
The unpredictability of the revenue
stream is likely going to make
administering some of these plans
not worth the cost.
- physician practice

27. Organizational requirements
and staffing for the various
educational and oversight
perspectives of managing value-
based payments is a challenge.
- hospital

28. TOP CHALLENGES TO FUTURE USE
0 0 0 0 0 0 0 0
Data management
Practice not suited
Model structure
Potential decrease in availability of care
Cost
Implementation
Staff acceptance, resistance to change
Standardization of terms and metrics
Decreased reimbursement, increased risk
Data accuracy
Uncontrollable parameters, care
coordination
Facility
Professional
0 10% 20% 30%
28

29. WE ASKED PROVIDERS IF THEY AGREE
THAT VALUE BASED-PAYMENT MODELS…
29
0 20 40 60 80
Improve quality of care
Improve patient experience
Improve population health
Will become dominant model
Are best suited for large markets
Are best suited for large
practices/facilities
Facility
Professional
0 20% 40% 60% 80%

30. TAKE A DEEPER
DIVE INTO THE
RESEARCH
Download a copy of this study
and others at availity.com

31. 31
1
2
3

32. NEED HELP SOLVING
PROBLEMS LIKE THESE?
Availity delivers revenue cycle and related
business solutions for health care
professionals who want to build healthy,
thriving organizations.

33. THANK YOU
LEARN MORE
availity.com | 800.282.4548