While adoption of value-based payment models in the U.S. healthcare system has been slow and at times arduous, a recently released report by the Health Care Payment Learning & Action Network revealed that as of 2020, an estimated 60.7% of payments were tied to quality or value in some capacity, including pay-for-performance, shared-savings, shared-risk, and population-based arrangements. The remaining 39.3% of payments were strictly fee-for-service. While these figures varied between traditional Medicare, Medicare Advantage, Medicaid, and commercial payers, these data appear to indicate an encouraging trend toward value-based payment adoption.
Meanwhile, in its October 2021 “strategy refresh,” the Centers for Medicare & Medicaid Innovation (CMMI) set the following goals:
- All Medicare beneficiaries with Parts A and B will be in a care relationship with accountability for quality and total cost of care by 2030.
- The vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.
As CMS and private payers look to engage in Alternative Payment Models (APM), creating a pathway to risk partnerships with providers can illustrate the advantages of moving to risk long-term while giving provider organizations time to adapt. But this requires investments in provider network management, population health, advanced analytics, and more.
I hope you’ll join me and my colleague Ryan Melander for our on-demand webinar as we review:
- The reimbursement landscape: past, present, and future
- The components of a well-designed APM for successful adoption and outcomes
- Best practices for effective interactions between payers and providers to support APM success
Don’t miss this opportunity to learn new ways to create a common language centered on risk and quality between payers and providers.