Report: More providers adopting value-based payment models, but plenty still hesitate to take on risk

A dollar sign created by Monopoly game houses is surrounded by Monopoly money. Dice and the car token appear next to the dollar sign as well.
Providers are increasingly jumping into APMs, but they're still slow to take on risk, according to a new report. (Getty Images/martince2)

The number of payments tied to value-based models continues to grow, but there’s more work to be done to drive providers to take on risk, according to a new report. 

The Health Care Payment Learning & Action Network released its latest progress report on the uptake of alternative payment models at its LAN Summit on Monday and found that 34% of payments in 2017 were tied to APMs that either were built on fee-for-service or use a population health-based approach. 

Last year, 41% of payments were tied to a fee-for-service model with no links to quality or value, and 23% were tied to fee-for-service models that do monitor quality and value. 

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APMs have grown steadily, according to the report, increasing by 23% over the past two years. However, most payments fall into shared savings models, with just 12.5% in 2017 falling into models with higher risk sharing. 

Adam Boehler, deputy administrator at the Centers for Medicare & Medicaid Services (CMS) and director of the Center for Medicare & Medicaid Innovation (CMMI), said at the summit that even this level of change in an industry that moves like “molasses” is impressive, as the movement toward value-based care started from nothing. 

“Healthcare has transformed a lot in that time,” Boehler said. 

RELATED: CMMI director—Home visits could be focus of upcoming Medicare demos 

Medicare Advantage is leading the charge on APM participation, according to the report. MA plans had nearly half (49.5%) of their healthcare dollars in these plans, compared to 38.3% of dollars in traditional Medicare. Commercial insurers and Medicaid lag behind, with 28.3% and 25% of healthcare dollars, respectively, in advanced payment models. 

The next step for the models, Boehler said, is for CMMI to determine the providers that are most ready to take on greater risk and get them into these more complex models. 

The agency is actively seeking ways to increase accountability in its APMs. CMS issued a rule in August that would move providers in the Medicare Shared Savings Program into a two-sided risk model more quickly. 

Patrick Conway, M.D., CEO of Blue Cross and Blue Shield of North Carolina and the former head of CMMI, echoed Boehler, agreeing that the movement to value-based care is entering a new phase. Conway said private payers like BCBS can and should take a leadership role in embracing risk-based models and accelerating the transition away from fee-for-service. 

RELATED: BCBS of North Carolina’s Conway—Still work to be done in transition to value-based care 

Conway said his team at BCBS of North Carolina can move more quickly than the federal government in trying to adjust incentives and push providers into these models. For example, in negotiating with primary care physicians on a new arrangement, BCBS agreed to turn off prior authorization to ease the reporting burden—and could do so almost immediately. CMS doesn’t have that same level of reactivity, Conway said, so private payer-led programs can really drive change. 

Other steps BCBS was able to take to push for more value include offering patients plans with a narrow network—which they are free to decline—and offering an online tool that provides cost data in an effort to push patients to lower-cost options, rewarding them with cash for those choices. 

“I want fee-for-service, volume-based care to die,” Conway said, “and I want to kill it as fast as possible.” 

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