Medical Groups' Risk-based Revenue Growing Slower Than Expected

Debra Shute, December 15, 2017

The American Medical Group Association calls on the government and other stakeholders to remove impediments to value contracts.

Medical groups and health systems expect that nearly 60% of their revenues from Medicare will be from risk-based products by 2019 and that Medicare Advantage will account for an increasing percentage of their business, according to a survey from the American Medical Group Association (AMGA).

AMGA's third annual risk survey examined how and when AMGA members are transitioning from reimbursements based on volume to payment models based on value.

Key findings include the following:

  • Medicare FFS payments are expected to decrease by 17% by 2019, while commercial fee for service payments will decline by 11%—rates slower than predicted by both the 2015 and 2016 surveys.
  • Fifty-nine percent of respondents stated that they have little to no access to commercial risk products in their local markets, which represents a small increase in payer engagement since 2015.
  • Revenues generated by accountable care organizations (14%–15%), whether federal or commercial, are not expected to increase by 2019, perhaps reflecting the plateauing success in ACOs.
  • In 2017, capitated payments equaled 17% of total payments to providers, while shared risk payments made up 13% of total payments.

Despite medical groups' progress toward risk-sharing, AMGA members are pursuing value in an uncertain environment, AMGA noted in a whitepaper.

"Commercial payers remain largely unengaged in the risk market. Lack of data sharing is a significant burden in succeeding in value arrangements, yet this practice remains endemic in the industry… . To reward this movement, Congress and HHS must address impediments to taking risk quickly or the groups that are most willing to make this transition will pare back their risk-based efforts," the authors concluded.

Debra Shute

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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