"The hardest part is [that] you still probably have both feet in the fee-for-service canoe, and you are lifting one foot out knowing you are going to put it in a capitated situation, but you can't put it down yet. You just can't put it down yet," West Virginia United's Jones says.
This creates a challenge for system leadership, he says. "You are trying to get people ready, but you can't really, fully implement because it doesn't work right now with payers."
Britt Berrett, president at Texas Health Presbyterian Hospital Dallas, says preparing to move to a value-based reimbursement structure without knowing where the tipping point is presents a major dilemma.
"I think I spend all my time preparing my team to be ready to change… The change management is going to have to be extraordinarily fast when the current reimbursement structures collapse," Berrett says.
Achieving Staff Buy-In
Reducing price variation and cutting the overall cost of care requires buy-in and a willingness on the part of clinicians and staff to change processes and procedures—something that is not always easy to achieve, says Patrick Cawley, MD, CEO at Medical University of South Carolina Medical Center in Charleston.