AMGA released the results of a survey of member medical groups and health systems that found that they expect nearly 60% of revenues from Medicare will be risk-based by 2019.
Survey respondents also said Medicare Advantage (MA) revenues from risk-based payments will equal Medicare fee-for-service (FFS) payments by 2019.
More than half of respondents said they have little or no access to commercial risk-based programs in their markets.
The AMGA’s third annual survey examined how and when AMGA members are moving from volume-based payments to a model based on value and added risk for providers.
Though value-based payments are becoming more the norm, barriers remain for value-based contracting. The survey found issues with data sharing, inadequate infrastructure, limited access to capital and a lack of commercial risk products. These issues impede more providers and systems from moving into value-based care.
The white paper also said respondents believe key healthcare stakeholders are not actively participating in value-based programs despite more providers moving into risk-based payments. Chester Speed, AMGA’s vice president of public policy, recommended that Congress and the HHS "address impediments to taking risk and to create incentives for other industry players to engage in the risk market."
AMGA members estimate that MA, Medicaid Managed Care Organizations, bundled payments and Medicare Accountable Care Organizations (ACOs) together will total nearly 60% of AMGA member revenues by 2019. That’s an increase from 53% this year.
AGMA members expect MA plans to intensify the move from FFS payments to value-based reimbursement. MA now makes up one-third of all Medicare beneficiaries and that number is expected to climb in the coming years. Enrollment grew by 8% between 2016 and 2017 and the CMS expects MA membership will grow by 9% to 20.4 million members in 2018.
The AMGA report mirrors other recent reports, which show a greater emphasis on value-based contracting. In a recent report, Health Care Payment Learning & Action Network said 29% of U.S. healthcare payments were connected to alternative payment models (APMs) in 2016. That was an increase from 23% the previous year.
Providers have been leery of taking on too much risk despite the increasing pressure from payers (both the CMS and private payers) to take on risk-based contracts that reward providers for quality and cost containment. However, the American Academy of Family Physicians and Humana recently reported that family physicians are warming to value-based payments. More than half of family physicians are participating in value-based payment models, and half of those surveyed believe value-based payments will lead to greater collaboration between primary care physicians and specialists.
With more providers moving into value-based payments, the American Hospital Association recently released a TrendWatch report offering advice about value-based programs. “There is no single model that will work for every organization. Hospital and health system leaders should assess the personnel, infrastructure and other capabilities required for success in each model when considering the most appropriate path for their organization,” according to the report.