Panelists Discuss Steady Growth of Two-Sided Risk Models

Nov. 10, 2022
Report shows an uptick in healthcare dollars tied to two-sided risk APMs across the Commercial, Medicare Advantage, and Medicaid lines of business compared to 2020 data, with Medicare Advantage showing the biggest increase of 5.8 percentage points

The percentage of healthcare payments tied to two-sided risk alternative payment models (APMs) continued to increase from 2020 to 2021, according to data released at the 2022 Health Care Learning and Action Network’s (LAN) annual summit. A summit panel of health plan leaders discussed the trends behind the numbers.

The LAN, launched in March 2015 by the U.S. Department of Health & Human Services (HHS), brings together public, private, and nonprofit sectors to link healthcare payments to quality and value through the increased adoption of alternative payment models (APMs).

The LAN has reported statistics on APMs since 2016 and released the 2022 APM Measurement Effort, a compilation of 2021 APM data, at this year’s meeting. In an ongoing effort to address health equity, the LAN also released Guidance on Social Risk Adjustment, which was described as a starting point for acting on three core components of social risk adjustment: data collection and tools, payment incentives and mechanisms, and care transformation.

The report shows an uptick in healthcare dollars tied to two-sided risk APMs across the Commercial, Medicare Advantage, and Medicaid lines of business compared to 2020 data, with Medicare Advantage showing the biggest increase of 5.8 percentage points. Traditional Medicare held steady from the previous year.  

The 2022 APM Measurement Effort indicates that in 2021: 

  • Medicare Advantage had 35.2 percent of spending in two-sided risk APMs .
  • Traditional Medicare had 24 percent in two-sided risk APMs.
  • The Commercial line of business had 12.7 percent in two-sided risk APMs.
  • Medicaid had 16.6 percent in two-sided risk APMs.

“I think the headline is that we've made a lot of forward progress in the past year creating more opportunities for providers to participate in alternative payment models, said Ellen Lukens, M.P.H., the deputy director of the Center for Medicare and Medicaid Innovation, during a panel discussion on the measurement results. “We increasingly understand that we need to meet providers where they are, that not all participants in our models are in the same place in their evolution toward value-based care, and we want to grow the base of providers that enter into value-based care arrangements. That may require additional support for things like infrastructure in transforming care. We also expect in the next few years that there will be new models, new cohorts and additional collaboration with our partners in the Center for Medicare on MSSP.”

Lukens added that with the ACO REACH model, there is momentum toward providing coordinated care and also improving the beneficiary experience, especially for underserved populations. “In the past year we have announced some specialty opportunities, the Enhancing Oncology Model as well as an additional cohort of Kidney Care Choices,” she said. “In addition to some of these models, in the physician fee schedule, we finalized our proposal to scale successful features of the ACO investment model in the Medicare Shared Savings Program. I think these new model opportunities really underscore our commitment to continuing to offer models designed to improve care for beneficiaries and reach a broad heterogeneous set of providers as we move to 2023. We will continue to announce and launch accountable care models that increase access to primary care for Medicare beneficiaries, while ensuring a focus on underserved populations.”

Chuck Chervitz, corporate regional vice president of payment innovation at St. Louis-based Centene Corp., focused on the Medicaid numbers. “When you look at the Medicaid results, you'll see that the category one fee for service is down 6.7 percent. Many people associate value-based contracting with Medicare and Medicare Advantage, but the reality is that providers have made a lot of investments in people and technology to be able to perform in those value-based contracts and they want to leverage those investments for Medicaid as well,” he said. “Now, that said, the efforts and the strategies necessary to be successful in a Medicaid model are different than Medicare and even Medicare Advantage. To me, the headline is we're moving in the right direction, but actual performance in the Medicaid models will require a bit of a learning curve because the efforts and strategies are different in Medicaid than in Medicare and certainly in Medicare Advantage.”

Christine Murphy, M.B.A., is senior vice president of provider partnerships at Point32Health, which brings together Tufts Health Plan and Harvard Pilgrim Health Care. She is charged with helping Point32Health achieve growth and affordability while strengthening and expanding their provider partnerships and network reach, with the goal of optimizing affordability and access.

 “I would say that the headline is slow adoption but really meaningful interest among the delivery systems, especially in the wake of the pandemic with its accompanying financial challenges, in alternative payment methodologies and in risk,” Murphy said. “I think the key will be collaboration with providers, hence my title ‘provider partnerships,’ moving beyond the traditional payer/provider dynamic, and leveraging a lot of the learning from existing ACO work to drive thinking inside the commercial book of business. Here in the New England market, we do have a few very high-performing primary care groups who have performed very, very well under risk and not just in the Medicaid and Medicare books, but also in the commercial book so it can be done. I think it's a question of who's making the investment and how they can do it in this post-pandemic world.”

Accountable Care Action Collaborative

Summit leaders also hosted a session on the LAN’s new Accountable Care Action Collaborative (ACAC), introducing its mission, vision, and goals and outlining long- and short-term opportunities to influence the accountable care landscape. The initiative seeks to advance accountable care through the aligned goals of ACAC member organizations and the LAN. 

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