Nearly 60% of Medicare revenues will be from risk-based contracts by 2019: 5 survey findings

Medical groups project a continued shift toward risk-based contracts in the coming years and increased Medicare revenues from these products, according to an annual AMGA survey.

It is the third consecutive year AMGA has asked members questions regarding the transition from fee-for-service to value-based care payment models. The most recent survey took place between June and August 2017. Seventy-four respondents from AMGA member groups completed the entire survey, although 80 respondents began the survey. Respondents primarily included AMGA members from multispecialty medical groups and integrated delivery systems.

Here are five findings.

1. Medicare fee-for-service payments and commercial fee-for-service payments are expected to drop 17 percent and 11 percent, respectively, by 2019. But AMGA notes these expected decreases are lower than projected in surveys from the previous two years.

2. Still, survey respondents indicated they are ready to take risk. They said they expect nearly 60 percent of Medicare revenues will be from risk-based contracts — such as bundled payment, Medicare Advantage, Medicaid managed care organizations and Medicare ACOs — by 2019.

3. In fact, respondents said they expect federal Medicare Advantage revenue to be essentially equal to Medicare fee-for-service payments by 2019.

4. However, there are still various impediments in transitioning away from fee-for-service, with one of the most critical challenges being access to administrative claims data, according to the survey. Other critical data challenges cited include "health plan data that is not actionable" and "reporting data to duplicative quality measurement programs."

5. The survey found 59 percent of respondents reported access to commercial risk products was not readily available in their local markets. "While this 59 percent represents an increase in payer involvement since 2015, the survey demonstrates that commercial payers are still largely not engaged in the risk market," AMGA states.

Access the full survey here.

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