We here at WebPT have been beating the value-based payment drum for a while now. After all, the signs are clear that we’re swiftly moving away from a fee-for-service payment environment in favor of one that is primarily based on value. And we’re not the only ones who see the writing on the proverbial wall: according to the Healthcare Financial Management Association (HFMA), “How well organizations can apply evidence-based best practices, improve seamlessness of care transitions, and provide wellness support to those living with chronic conditions is becoming integral to their success in this new era of health care.”

Jim Landman, HFMA’s director of healthcare finance policy, perspectives, and analysis, chimed in on the subject as well: “I think any doubts about whether we are transitioning to more value-based payment and care delivery models have been dispelled. With CMS detailing specific targets for transitioning to value-based payment and private payers clearly expressing their intent to accelerate the transition, now is the time for providers to focus on their capabilities to manage the transition, if they haven’t done so already.”

So, what are the “capabilities” that Landman is talking about? Well, as part of a Humana-sponsored study designed to assess the transitional readiness of healthcare organizations by surveying 146 senior financial executives, the HFMA identified nine key capabilities—which we’re calling keys—that it believes providers must have to successfully unlock value-based reimbursement. Below is the list from the HFMA (also available in slide format here).

The Keys

Key 1: Eligibility Verification

“The ability to effectively identify patients covered under a value-based payment arrangement.”

Key 2: Interoperability

“The ability to aggregate clinical information across networks and between hospitals and…practices.”

Key 3: Business Intelligence

“The ability to collect, analyze, and model data.”

Key 4: Real-Time Data Access

“The ability to provide meaningful data to care providers at the point of service.”

Key 5: Care Standardization

“The ability to provide infrastructure that supports use of data to standardize care processes.” (Outcomes tracking, anyone?)

Key 6: Assessment of Return

“The ability to monitor value-based contracting revenue opportunities versus costs of implementation.”

Key 7: Chronic Care Management

“The ability to provide systems and processes that support wellness and management of patients with high-volume, high-cost chronic disease.”

Key 8: Post-Discharge Follow-Up

“The ability to support patients post discharge with systematized follow-up (e.g., home health services, structured patient follow-up protocols).”

Key 9: Flexible [Provider] Compensation

“The ability to compensate [providers] in a way that flexes to accommodate both fee-for-service and value-based models.”

The State of Affairs

Now, before you start worrying because your practice doesn’t have all nine key capabilities down pat just yet, you should know you’re not alone. Respondents rated Eligibility Verification (Key 1) as the only item their organizations were already highly or extremely capable of performing more than 50% of the time (57.5%, to be exact). So, clearly, there’s still work to be done before the healthcare industry on the whole will be able to take full advantage of value-based payment models. As one survey respondent said, “Changing our culture and mind-set from health care being a volume-based industry isn’t easy. We’re still trying to understand all the nuances in how a provider will be profitable under a value-based payment system.” However, there is good news: more than 50% of all respondents reported already seeing a positive return on investment (ROI) from value-based payment programs. (Hooray!)

The Next Steps

Wondering what you can do now to ensure your practice gets a piece of that positive ROI? The HFMA recommends:

  • Acknowledging that there is no one-size-fits-all solution. That way, you can find the approach that works best for your clinic based on risk capacity, demographics, and market.
  • Working with payers to maximize existing value-based efforts. (In the words of Susan Horras, HFMA’s director of healthcare finance policy, health plan, and population health initiatives, “Successful providers not only perform to quality metrics but also collaborate with payers to reduce the administrative burden around reporting wherever possible.”)
  • Fostering provider-payer data-sharing so you know what’s working well and what isn’t—“both clinically and financially.”
  • Minimizing financial risk by first transitioning to “upside only” payment models—or at least models that cap potential losses at a comfortable limit.

Value-Based Best Practices

Here are several more best practices for value-based success (adapted from Humana’s list):

For the full list of best practices, click here, and to learn more about HFMA’s Value Project work, click here.


How many keys does your clinic currently hold? Tell us how you’re preparing for the transition to value-based payment in the comment section below.