Survey Illustrates High Receptiveness From Payers to Alternative Payment Models

The Health Care Payment Learning and Action Network (LAN) recently released the results of its survey tracking the progress of payers and providers as they adopt value-based alternative payment models, as health care shifts from fee for service (FFS), volume-based care, to one based on value.

The 2022 Alternative Payment Model (APM) survey was conducted from May to July 2022, with a total of 63 health plans, 5 fee for service (FFS) Medicaid states, and traditional Medicare participating. These health plans and states represented approximately 233,870,081 of the nation’s covered lives and 77.7% of the national market.

According to Matt Eyles, AHIP’s president and CEO, the major purpose of this survey is to continue to identify ways in which insurance companies can help participants have increased access to quality, affordable health care for better health outcomes. The 2022 LAN APM Measurement Effort combined data from the AHIP survey, the Blue Cross Blue Shield Association survey, the LAN survey, and traditional Medicare data provided from CMS.

Health plans and states provided retrospective data on actual dollars paid to providers during the previous calendar year (CY) or the most recent 12-month period for which the data was available.

APMs received 40% of health care payments, across all payer types.

Subscription to risk-based models rose with 1 in 5 (20%) of payments in US health care ascribed to risk-based advanced payment models.

Some of the findings of the survey include:

• More plans targeting health equity improvements through value-based payment models. For instance, 46% are incentivizing providers to collect standardized race, ethnicity, and language data, and 37% are incentivizing screening for socioeconomic barriers.
• In response to those socioeconomic barriers, 34% coordinated delivery strategies to address them.
• The majority—96%— of payers agree/strongly agree that APM adoption will improve quality of care and better care coordination, while 82% believe it will result in more affordable care.
• The top 3 responses by payers regarding barriers to full adoption of APM were the receptivity of providers to adopt financial risk, the ability for providers to operationalize, and provider interest/readiness.
• Conversely, the top 3 incentives were health plan interest/readiness, influence of the government, and the interest/readiness of providers.
• Advanced payment models made up 51% of payments in Medicare Advantage (MA) plans, with 35% of payments crossing risk-based advanced payment models.

The usage of MA plans reflects members’ recognition of the plan as one that is both valuable and affordable, Eyles said. Between CY 2019 and CY 2020, payments made to increase the quality of care at a foundational level showed a substantial increase of 2%.

Limitations for this survey include voluntary participation; self-selection bias when answering questions on behalf of health plans and states pursuing payment reform; possible variability created by differences in the interpretation of metrics; and technological challenges in recording the data in the system.

Commenting on the results, Eyles also said that value-based payment models were a steady force among the uncertainty of the circumstances of the COVID-19 pandemic. “These findings support what we have heard from our members, particularly over the last 3 years: Value-based payment models are not only good for patients, they are good for clinicians, hospitals and health care systems by supporting these partners through greater financial predictability, stability and flexibility even in the most dire health crises,” he said in a statement.