CPRofficials said the numbers show that current payment reformapproaches are having less impact than they should.

A new study by a health care employer group finds that althoughproviders are adopting payment reforms that aim to improve qualityand affordability of health care, the industry overall is movingslowly and cautiously—meaning that reforms are having a limitedeffect.

As part of the larger health care reform movement that includedthe Affordable Care Act, many in the health care industry havecalled for payment reforms as a way to set qualitystandards while at the same time reducing wasteful health carespending.

Related: Waste accounts for a quarter of health carespending

Catalyst for Payment Reform (CPR) released a set of national scorecards that shows providersare tending to adopt weaker versions of payment reform and largelydeclining to take on more risk. CPR's study, which was funded bythe Robert Wood Johnson Foundation, looked at the types ofvalue-based care and found that most of them had little downsidefor providers if they didn't meet quality standards.

Little appetite for risk

The good news from the report was that adoption ofvalue-oriented or "alternative payment methods" grew from 10.9percent of payments to providers in 2012 to 53 percent in 2017. But90 percent of those methods were built on fee-for-service systems,which could mean that providers still had more incentive to providequantity of care over quality.

The study further found that only 6 percent of total dollars in2017, the latest year for which that data was available, flowedthrough payment methods that had downside financial risk toproviders. The researchers found that that number has beenrelatively consistent since 2012 when it was 5.7 percent.

CPR officials said the numbers show that current payment reformapproaches are having less impact than they should. "The results ofthese analyses are disappointing and a wake-up call that we aremoving too slowly and essentially missing the mark," said Robert S.Galvin, MD, chair of CPR's board. "Not all payment reforms areequally effective and it's time to put our energy toward paymentmethods that don't rely on fee for service but, instead, empowerhealth care providers to manage our populations and assumefinancial risk for their performance."

Quality and cost are both in the mix

The study examined data from the years 2012-2017. The rate ofgrowth of payment reforms was greater in the earlier years of thattime period, the study showed. Shared savings payment reforms werethe most popular, followed by pay-for-performance—both methods setincentives for providers to reduce unnecessary care and thereforelower costs. Bundled payment reforms, where providers are paid asingle, "bundled" payment for an episode of care, were a smallpercentage and grew only slightly through the five-year timeperiod, representing 1.6 percent of dollars paid to providers in2012 and 2 percent in 2017.

CPR officials say that in today's market, payment reform cannotjust be about improving quality, it must also look ataffordability. The study noted that in 2013, 7.45 percent ofpatients with commercial health insurance were unable to receivecare due to cost concerns. By 2017, that number had risen to 9.68percent of patients.

"Given the growing recognition that high prices are the majorreason health care costs continue to rise while the use of servicesremains flat, CPR's view now is that it's not real payment reformif it doesn't address prices," said Suzanne Delbanco, PhD,executive director of CPR.

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