ALEXANDRIA, Va.--(BUSINESS WIRE)--AMGA today offered recommendations to the incoming Trump-Pence Administration and Congress to further the transition to a value-based healthcare system, based in part on a new membership survey that found significant obstacles are slowing the transition. Impediments include limited access to claims data, risk-based insurance contracts, and investment capital.
The survey of AMGA members—multispecialty medial groups and integrated systems of care that deliver care to one in three Americans—found that 58 percent are ready to embrace alternatives to fee-for-service payments, including downside risk, within two years, but that commercial payers generally are not offering risk products in their local markets. Moreover, respondents predicted that a smaller percent of future revenue will come from more advanced risk-based arrangements like shared-risk and partial- or full-capitation products, and that fee-for-service payment will account for a larger share of revenue than they anticipated in a similar 2015 survey.
“AMGA members are leaders in the movement toward value-based care models, and they have invested the time and resources to succeed under risk-based payment arrangements,” said Donald W. Fisher, Ph.D., CAE, AMGA’s president and chief executive officer. “Our suggested reforms will improve federal policies that help ensure the healthcare system truly transforms to one based on value.”
AMGA recommendations provide health systems and others the tools needed to succeed in a value-based payment model and address the following:
- Data improvements: Congress should require federal and commercial insurance companies and providers to standardize data submission and reporting processes, as well as to provide access to all administrative claims data to healthcare providers.
- Access to capital: Congress should create a fund that allows providers to use income on a tax-free basis to invest in taking downside risk.
MACRA (Medical Access and CHIP Reauthorization Act): For
success under Alternative Payment Models (APMs), Congress should:
- Not penalize Advanced APMs if there are insufficient risk products in their local markets
- Allow Medicare Advantage revenue to count in performance year 2019 toward meeting the Advanced APM revenue thresholds
- Allow Track 1 ACOs to be eligible as Advanced APMs
These recommendations are based on impediments to risk identified in the survey, detailed in the white paper “Taking Risk, 2.0: Is the Transition to Value Slowing? AMGA’s Second Annual Survey on Taking Risk,” including:
- Immature risk market: 64% report none to limited commercial value-based or risk-based products in their local markets.
- Lack of access to claims data: Providers are not able to access administrative claims data from all payers. Without this data, it is nearly impossible to manage quality and cost.
- Non-standard data: Providers have to submit data in different formats to different payers, creating a massive administrative burden.
- Limited access to capital: Access to capital is an acute issue that delays investments in the infrastructure necessary to take risk. Lack of capital access also drives consolidation.
- Inadequate infrastructure: Necessary infrastructure is expensive and difficult to implement, and it requires significant change management.
“AMGA members are working diligently to provide high-quality health care in a value-based payment environment,” said Chester A. Speed, J.D., LL.M., vice president, public policy, AMGA. “But without access to commercial risk products and appropriate data that’s exchanged in a standardized way, it will be difficult for them to fully succeed under risk-based reimbursements.
“In our 2015 white paper on taking risk, we noted that if these obstacles were not addressed, we expected to see a slower transition to value. This year’s data indicate that the slowdown already is occurring. These problems must be addressed or the laudable goal of transitioning the healthcare system to one that rewards value will be unnecessarily delayed at best, or grind to a halt at worst,” Speed noted.
The AMGA survey was conducted between April and July 2016 and included 115 respondents representing 168 member organizations. A white paper detailing results of the 2016 risk survey is available on the AMGA website at www.amga.org/risk2wp.
For a summary of the obstacles to risk, please see AMGA’s infographic.
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of medical groups’ recognized excellence in the delivery of coordinated, high-quality, cost-effective care. More than 170,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, amga.org.