Multi-specialty medical groups transitioning to risk-based payments


Multi-specialty medical groups (MSMGs) and integrated delivery systems (IDSs) expect fee-for-service payments to decline by 24 percent over the next two years, yet barriers are slowing the transition to value-based care.

That is the key finding of a survey by the The American Medical Group Association (AMGA). 

The survey found that among commercial insurers, a lack of access to administrative claims data, a lack of transparency into cost and quality data and ineffectiveness of attribution methodologies rated as the highest areas of concern. 

Concerns with Federal programs included ineffective attribution, benchmarking and risk adjustment methodologies, followed by the lack of a standardized data submission and feedback processes. While both financial and data issues were included, data issues were perceived as more significant.

Respondents also noted a lack of risk offerings from insurers in their local markets, preventing them from being able to take the necessary risk. Twenty-two percent of survey respondents indicated that no insurers were offering risk-based products in their market, while 48 percent stated that only one-to-19 percent of insurers were offering risk-based arrangements in their market.

The survey also showed that 41 percent of respondents needed between three to five years before they could accept downside risk, while 17 percent stated they needed more than six years to accept downside risk. This demonstrates that transitioning to risk may take longer than policymakers anticipate.

Results show revenues from commercial Accountable Care Organizations (ACOs) and partial- and full-capitation arrangements are expected to double by 2017. Revenues from Federal value-based arrangements such as ACOs and Medicare Advantage are expected to grow between 20 and 36 percent. 

These payment changes are occurring as Congress and the Department of Health and Human Services (HHS) embark on an ambitious plan that essentially mandates providers accepting payment risk over the next several years.

Importantly, the survey also detailed tools that the Federal government and commercial payors can offer providers to accelerate the transition to risk-based payments. 

Access to administrative claims data, improved data transparency and data exchange processes, and improved attribution, benchmarking and risk-adjustment methods will help providers, payors, and patients succeed in a new value-based payment system.

“Our members understand the importance of transitioning to a value-based payment system, in fact many are already moving in that direction,” said Chet Speed, vice president, public policy at AMGA. 

“This transition will be challenging and medical groups need policymakers and commercial insurers to partner with them to offer the tools they need to be successful in a new risk environment. We at AMGA look forward to working with Congress, HHS and the commercial sector to implement the strategies that will drive success in a value-based healthcare system.”

AMGA, Chet Speed, US