Medicaid MCO Survey: Providers Still Reluctant to Adopt APMs

Nov. 20, 2023
Asked to name barriers to adoption of value-based payment, 91 percent of MCO respondents cited provider readiness and willingness and 83 percent said health plan-provider data sharing capabilities

Among its many other insights, the recently released Institute for Medicaid Innovation's (IMI) annual Medicaid managed care survey identifies ongoing barriers to the adoption of value-based care and alternative payment models.

The IMI survey captures information from 11 core domains ranging from behavioral health and child and adolescent health to telehealth and value-based purchasing. The surveys represent 31 of the 41 states with Medicaid managed care. The findings from the survey are intended to equip Medicaid stakeholders with the information needed to accurately articulate the national narrative about Medicaid managed care.

“CMS is committed to transitioning providers in the U.S. to value-based healthcare. We also know that clinical practices are struggling to make that transition,” said Jennifer Moore, Ph.D., R.N., during a recent webinar on the survey’s findings. “Our survey reflects that reality. Medicaid health plans share that they're continuing to experience challenges with provider willingness to adopt alternative payment models. As we all know, the challenges of taking on both upside and downside risks persist."

When asked about external barriers that influence the adoption and innovation in value-based payment, 91 percent said provider readiness and willingness; 83 percent said health plan-provider data sharing capabilities; 74 percent said provider staffing shortages; and 52 percent said Medicaid payment rates. 

When asked what changes to state requirements and guidance would assist Medicaid health plans to effectively implement value-based payments, 65 percent said provision of additional policy and/or fiscal levers for MCOs to ensure provider engagement in VBP models. Sixty-five percent said better education for providers on state and health plan expectations. Another 65 percent said reporting of consistent metrics, and 61 percent said policies to facilitate data sharing between payers and providers.

A response panel during the webinar included Poppy Coleman, M.P.P., manager of the UPMC Health Plan Government Products Encounter Team. She said one surprising thing to her about the survey is that although value-based care is consistently seen as a priority for states and federal regulators of Medicaid, there is still such difficulty getting providers on board. “I think this is especially interesting when we consider another data point — that less than half of the plans that responded are using downside risk. So there's not even downside on the table for these providers, and still there's some kind of difficulty getting them on board.” 

Lindsey Browning, M.P.P., program director for Medicaid operations for the National Association of Medicaid Directors, said she was also struck by the challenge around provider willingness to engage in value-based payment.  “What really caught my eye was the notion that the health plans are looking for their state partners to open up some new policy and fiscal levers to shift that perspective,” she said. “As an organization that works with state Medicaid policymakers, I was really fascinated by that and hope there can be some more conversation to explore what some of those opportunities might be.”

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