Health Care Payment Learning & Action Network Releases Report on Alternative Payment Model Efforts
In late 2022, the Health Care Payment Learning & Action Network released a report on the implementation of value-based care across the healthcare industry. According to the report, the is overall stability in value-based care participation across all of the categories surveyed. However, Medicare Advantage (MA) plans are leading in the adoption of downside risk payment model participation.
The survey covered five states and 73 health plans and traditional Medicare. It found that 40.5% of Medicare and plan spending in 2021 was for providers in a fee-for-service model with no connection to quality or value, a slight increase from 39.3% in 2020.
According to the survey, 35.2% of MA payments to providers went to a combination of alternative payment models that have two-sided financial risk – an increase from 2020 when only 29.3% of spending went to those models. Additionally, there was a marked decrease in MA spending in one-sided risk payment models where the providers have no financial risk for missing savings targets. In 2021, that spending only made up 21% of MA spending compared to 28.7% of MA spending in 2020.
For traditional Medicare, 24.0% of payments were for a two-sided financial risk payment model in 2021; for Medicaid, 16.6% of payments in 2021 were for a two-sided financial risk payment model; and in commercial insurance, 12.7% of payments in 2021 were a two-sided financial risk payment model.
Overall, the study found that 19.6% of United States health care spending was on a two-sided risk model, compared to 17.9% in 2020.
“We’re behind the providers in their journey across the risk spectrum,” said Diwen Chen, vice president of payment innovation for Elevance Health (formerly known as Anthem), at the Learning & Action Network Summit in November 2022.
Alternative Payment Model Adoption
When asked about APM adoption and the impact it would have on the industry, 96% said it would result in better quality of care and improved care coordination (4% strongly disagree/disagree). Only 10% of respondents felt APM adoption would result in higher unit prices for discrete services while 56% strongly disagreed/disagreed with the idea and 34% were unsure of the impact APMs would have on unit prices for discrete services.
Health Equity
The survey also asked plans about their goals and intentions to work towards improving health equity. According to the response, almost half (46%) are using value-based provider arrangements to get providers to collect standardized race, ethnicity, and language data while 40% use participation in quality improvement collaboratives.
When asked about what specific social determinants of health (SDoH) or delivery strategies plans intended to improve, 37% said screening for socioeconomic barriers known to impact health or health outcomes, 34% said care coordination for services that address socioeconomic barriers, 31% said multidisciplinary team models (i.e., social worker, community health worker, medical staff, doulas, etc), and 28% said referrals to community-based organizations to address socioeconomic barriers. Other SDoH mentioned included: safe transportation, food insecurity, social isolation/loneliness, and housing insecurity.