AMGA says transition to value-based care slowing

Capitol Hill
“The transition to risk-based arrangements is slowing, and there are very real obstacles in the way,” said Donald W. Fisher, AMGA’s president and CEO.

While healthcare continues to move toward value-based care, that transition has slowed, and physicians still need help from insurers and policymakers to succeed under new payment models.

Based on a survey of its members that shows a slow-down in the value-based care transition, the American Medical Group Association (AMGA) said in a press conference that Thursday it will make recommendations to the incoming Trump administration and Congress to remove impediments that limit access to claims data, risk-based insurance contracts and investment capital.

Congress should require federal and commercial insurance companies and providers to standardize data submission and reporting processes, as well as to provide access to all administrative claims data to healthcare providers, according to the trade association.

Digital Transformation

Unlock the Digital Front Door with an App

The Member Mobile App is the smarter and better way to engage members anytime and anywhere. Members can find the right doctors, receive alerts, track spending, use telehealth, and more — all within a guided, intuitive, and seamless experience. Built exclusively for payers, it is ready to install and launch in a few months. Request a consult on how to enable the digital front door with the Mobile App, today.

A 2016 survey by the AMGA found that fee-for-service payments to multispecialty groups and integrated delivery systems continued to decline by more than 20%, with value-based payments increasing proportionately, according to a report (PDF) from the trade association. The report can be downloaded free from the association website.

However, while a majority of the 115 respondents are ready to accept downside risk within two years, they also reported that commercial payers generally are not offering risk products in their markets.

“The transition to risk-based arrangements is slowing, and there are very real obstacles in the way,” Donald W. Fisher, AMGA’s president and CEO, said during the press conference.

The report indicated that impediments to taking risk identified by AMGA members last year—including data-sharing issues and the lack of commercial risk products—have largely not been addressed. Here are some of the obstacles the report identifies:

For instance, in Montana there are no commercial risk products currently available, Heidi Duncan, M.D., the physician director of health policy at Billings Clinic, said during the press conference. Another problem is that healthcare organizations need complete and accurate real-time data in order to manage the health of patients, she said.

The report comes as physician practices begin to transition to the new Medicare payment system to implement the Medicare Access and CHIP Reauthorization Act, with the goal of the Department of Health and Human Services tying 90% of Medicare payments to “value” by 2018.

Private payers have not moved as quickly, and the AMGA said it will recommend steps to Congress to keep the transition to value-based care moving ahead. The group recommends Congress create a fund that allows providers to use income on a tax-free basis to invest in taking downside risk and allow access to capital.

It also recommends steps to help physicians succeed under MACRA’s Alternative Payment Models (APMs), including not penalizing Advanced APMs if there are insufficient risk products in their local markets, allowing Medicare Advantage revenue to count in performance year 2019 toward meeting the Advanced APM revenue thresholds, and allowing Track 1 ACOs to be eligible as Advanced APMs.

The AMGA's 2015 survey noted that if policymakers did not address obstacles, the transition to value-based payment systems would slow. “According to this year’s data, that deceleration is already occurring. Congress and HHS need to address these impediments soon, or the transition to value will either be unnecessarily difficult and prolonged, or it may grind to a halt much like it did in the 1990s,” the AMGA's new report concluded.

Suggested Articles

Vaccination rates for Medicaid and CHIP declined precipitously as well as rates for health screenings for children due to COVID-19, CMS reports.

Anthem and Humana quickly had to pivot to handle food insecurity issues among its Medicare Advantage members at the onset of the COVID-19 pandemic.

There is a potential legal skirmish brewing two of the largest telehealth companies over patent claims.