Webinar: The path to adopting a successful Alternative Payment Model

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.