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By the numbers: Proportion of Payments that are Value-Based

Jul 02, 2018

Several weeks ago, Darwin CEO John Marchica presented at ExL’s 11th Partnering with ACOs and IDNs Summit. During the conference, one of the presenters suggested that less than 10 percent of payments in the United States were value-based. That seemed low.

We did a little digging into what payers are saying about their move to value-based payment models and found that while there is significant variation among commercial health insurers, all were well beyond the 10 percent mark. For instance, 64 percent of Humana’s Medicare Advantage members are in value-based care models.

For comparison, a recent analysis by the Health Care Payment Learning and Action Network (LAN) found that in 2016, only 43 percent of health care dollars were from traditional fee-for-service or other legacy payments not linked to quality, compared with 62 percent in 2015. The analysis showed that 28 percent of health care spending came from reimbursement models with pay-for-performance or care coordination incentive payments, and 29 percent of health care payments were through shared-savings or shared-risk arrangements, bundled payments or population-based reimbursements.

Data sources for the study included LAN, America’s Health Insurance Plans, Blue Cross Blue Shield Association and CMS, representing 245 million people (84 percent of the covered U.S. population).


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