Slightly more healthcare payments flowed through high financial risk advanced payment models (APMs) in 2018 compared to 2017, as payers are showing growing enthusiasm for such models, a new report said.
A survey released by the public-private partnership Health Care Payment Learning & Action Network (LAN) showed that nearly 36% of total U.S. healthcare payments in 2018 went to APMs that required some type of financial accountability from providers, a slight increase from 2017. The survey features payers in traditional Medicare, Medicare Advantage, Medicaid and commercial plans.
“This progress is part of a continuing, big-picture trend in health care payment reform since the LAN was established in 2015,” the group said in a release. “Four years ago, one in four health care payments flowed through an APM, and today that ratio is one in three.”
The report broke APMs into four categories. The first category is fee-for-service with no link to quality, and the second covers fee-for-service payments linked to quality.
The third and fourth categories hold providers financially accountable for not meeting appropriate care measures or cost targets.
LAN found that 35.8% of total U.S. healthcare payments in 2018 were tied to an APM in category three or four, an increase from 34% in 2017. The survey found that 41% of healthcare dollars were sent to category one and 25% sent to category two. The percentage of payments to APMs differed based on the type of payer.
LAN examined data from the Centers for Medicare & Medicaid Services (CMS) and talked to 62 health plans and seven states for fee-for-service Medicaid.
Medicare Advantage plans had 53.6% of their healthcare dollars in categories three and four, while traditional Medicare had nearly 41% of its payments in such APMs, the report said.
Meanwhile, commercial insurers surveyed had 30% of their dollars in high-risk APMs, and Medicaid had 23.3%.
CMS has sought to spur greater adoption of APMs and value-based care over the past couple of years. The agency recently put out a proposed overhaul to the 1989 Stark Law that bans self-referrals from physicians because of industry complaints it was hindering value-based care arrangements.
The survey showed a large enthusiasm for APMs among healthcare payers. LAN found 97% of respondents believe APMs will lead to better quality and 88% think they will cause more affordable care.