34% of healthcare payments were tied to value-based care last year, report finds

October 22, 2018 | Kelly Gooch

The percentage of U.S. healthcare payments tied to value-based care increased in 2017 to 34 percent, according to a report from the Health Care Payment Learning and Action Network, a public-private partnership launched by HHS.

The report suggests an increase from 23 percent over two years.

For the report, the network examined fee-for-service Medicare data. It also examined data from 61 health plans and three fee-for-service Medicaid states on in- and out-of-network spending tied to alternative payment models, such as shared savings, shared risk, bundled payments and population-based payments. That included any available pharmacy and behavioral health spending.

The report found 34 percent of healthcare payments, representing about 226 million Americans and nearly 80 percent of the nation’s covered populations, came through these two categories of the network’s Refreshed APM Framework: alternative payment models built on fee-for-service architecture and population-based payment. That compares to 41 percent of healthcare payments that were based on volume and not linked to quality and efficiency.

In comparing value-based payment adoption across markets, the amount of alternative payment models for commercial, Medicare Advantage, Medicare fee-for-service and Medicaid business lines were 28.3 percent, 49.5 percent, 38.3 percent and 25 percent, respectively.

“The report’s findings reinforce our understanding that there is sustained, positive momentum in the effort to shift healthcare payments from traditional fee-for-service into value-based payments,” said Mark McClellan, co-chair of the network’s  guiding committee and director of the Robert J. Margolis Center for Health Policy. “While we celebrate the increase in overall APM adoption, we also know further progress on payment reform will be important to ensure healthcare dollars flow through models that have more risk.”

Access the full report here.

Source: Becker’s Hospital Review