Most health system leaders said their organizations will continue shifting to value-based care, despite uncertainty surrounding a potential repeal and replacement of the ACA, according to a leadership survey by national healthcare advisory firm BDC Advisors.

The survey findings, published in the Healthcare Financial Management Association’s Leadership magazine, were based on conversations with CEOs and chief strategy officers from major health systems and academic medical centers. BDC Advisors said its recent conversations included 12 C-suite leaders from California, Florida, Massachusetts, Maryland, New Jersey, Pennsylvania, Arizona, Louisiana and Ohio. Interviews took place over the last two months, coinciding with the introduction and later House passage of, the American Health Care Act.

Most leaders believe many of the healthcare market’s characteristics and challenges are unchanged from when the ACA was introduced in 2011, the survey findings show. Study authors said organizations still face the issue of revenues not keeping up with cost growth. In addition, health systems remain concerned about quality and value and find it challenging to break even on government programs. While there is uncertainty surrounding future Medicaid funding and the ACA marketplaces, commercial insurance “will remain the main avenue of growth, scale will remain critical and the move toward value-based reimbursement will continue,” according to the survey findings.

One executive noted providers are “hunkering down,” meaning they are “continuing down existing paths while slowing major capital investments,” study authors wrote. And one executive said the focus now is on “no regret” strategies addressing “fundamental economic forces.” These include cost pressure, the rise of consumerism, the shift from inpatient to outpatient care and the growth of population health management.

Study authors said providers overall believe the shift to value-based care will largely continue, although some executives noted the current political uncertainty may suggest organizations that have not yet made progress on innovative models should not begin now. Those issues, along with the “hunkering down,”could possibly lead to, at least in some areas, a slowing of momentum created by the ACA toward care coordination and value-based care, they said.

“Overall, the organizations facing the biggest challenges in this tough environment will be providers with significant Medicaid and ACA marketplace business,” the study authors concluded. “In a low-margin industry, those organizations will struggle to manage profitable growth.”

 

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