More payments are value-based than you might think

The Health Care Payment Learning and Action Network released a measurement of Alternative/Advanced Payment Models (APM) for 2023, showing the types of payments physicians and providers received overall and based on payer type. The measurements show a positive trend toward value-based care (VBC) payments, and the breakdown by payer was even more telling.

It's not a big surprise that most payment in the Commercial and Medicaid worlds is based solely on fee-for-service (FFS). However, the percentage of strict FFS is lower than one might expect – 54.5% for Commercial and 50.1% for Medicaid. Most of the remaining percent for both show payments based on shared savings linked to quality metrics and utilization outcomes.

In Medicare Advantage plans, 61.8% of payments were made somewhere on the VBC spectrum, most in shared savings tied to quality and outcomes with capitation coming in a close second. Traditional FFS Medicare had 84.1% of payments landing somewhere in the VBC spectrum with most being pay for performance or pay for quality.

The authors point to “provider readiness” and ability to operationalize as two large facilitators and/or barriers to the move to VBC. They also share that almost two-thirds of payers anticipate that this movement to APM will continue to increase.

This report confirms the steady move to VBC contracting in healthcare and highlights the need for organizations and practices to lay a solid foundation of processes and workflows to ensure appropriate patient contact and care, such as in Medicare Annual Wellness Visits (where numerous VBC facilitations can occur) and HEDIS Measures of prevention, screening, and chronic disease management. Doing so allows for payments based on activities, plus it sets a practice up for outcomes success as more risk is taken through shared savings or capitation.

Technology can be leveraged, through tools like Affirm Health’s platform, to facilitate the building of this foundation, as well as the continued success as an organization or practice travels through the VBC spectrum to full risk. Even if a practice is not focused on Medicare patients, the movement toward VBC payments in Commercial and Medicaid plans signifies a growing need for similar work to be done in these payer populations.

Source: https://hcp-lan.org/apm-measurement-effort/2023-apm/