AMGA survey: Risk-based revenues are rising

Members of the American Medical Group Association (AMGA), which represents more than 175,000 physicians, are bullish on taking on risk, with more member revenues coming from risk-based models in 2018, according to a recent survey on the transition to value-based care.

Overall, respondents noted that 56% of revenues came from value-based payment models, including 30% from Medicare Advantage and 15% from the federal ACO program. Bundled payments made up only 1% of revenue. MA revenues were up from 22% in 2015, while ACO revenues jumped 36% from 2015 to 2018.

“When comparing survey responses from the 2015 and 2018 surveys, it is clear that AMGA members are moving to value,” Jerry Penso, MD, MBA, AMGA president and CEO, said in a statement. “AMGA members believe value-based models support their team-based, coordinated, data-driven model of care, which results in better patient outcomes.”

Looking ahead, value-based care revenues are expected to be an even higher proportion of overall revenue. By 2020, MA revenues will outpace Medicare fee-for-service revenues by 6%, while downside risk ACO revenues will double that of upside only ACOS, respondents predicted. Bundled payments are likely to remain flat in 2020.

In the commercial setting, risk-based revenues were lower, at just 28% of total revenues in 2018. However, that is likely to jump to 27% in 2020. The 2018 level of shared-risk ACO revenues of 6% will almost double to 11% in 2020. Share-savings ACO revenues are expected to increase from 10% in 2018 to 12% in 2020.

The increase in risk-based ACO revenues over he next few years in both the federal and commercial setting could reflect the recent rules by CMS to push ACO participants into risk-based models sooner.

While AMGA members are moving toward value, there are several obstacles to shift away from fee-for-service models. For one, members noted that building the infrastructure to support value-based care models and financing it is an impediment. The most significant external challenge was having access to administrative claims data to achieving value-based care, according to the survey. Without shared data, it is difficult to manage large populations of patients in risk-based arrangements. Furthermore, sharing that data across providers or platforms is also difficult, while having to report on hundreds of quality measures contributes to burnout.

“This year’s survey shows AMGA members are making the costly financial investments necessary to address impediments within their control,” Chet Speed, JD, LLM, AMGA chief policy officer and primary author of the report, said in a statement. “However, the survey responses also indicate that AMGA members are frustrated over the lack of attention external impediments are receiving from stakeholders and policymakers. These barriers must also be addressed to ensure momentum towards value-based care is not halted.” 

Fortunately, providers have been working on removing internal impediments “within their control” from 2015 to 2018, including working on infrastructure supports. In addition, more providers are making investments to further their transitions to value-based care.

See the full survey here.