The theme of The 2017 OPEN MINDS Performance Management Institute was the move to value-based reimbursement. We had lots of great presentations on both health plan and provider organization value-based program innovations. But as a whole, where exactly are we on the path to value-based reimbursement?
The move to managed care is continuing across all payer sectors and those payers are now including provider organizations in risk-based arrangements. More than 2.2 million Americans are in Medicare Advantage Special Needs Plans (Medicare Specialty Vertical Carve-Out Plans: The 2016 OPEN MINDS Medicare SNP Market Share Report). And, the Medicare fee-for-service plan is undergoing a transformation by moving reimbursement to a variety of risk-based models (see What Is MACRA & How Does It Affect Clinical Professionals?: An OPEN MINDS Market Intelligence Report).
In Medicaid, more than 68% of the population is enrolled in comprehensive managed care organizations (MCO). Of the 38 state Medicaid programs that use at-risk capitated contracts with managed care organizations (2016), 16 states (42%) include some kind of requirement for the MCOs to reimburse provider organizations using alternate payment methodologies (APMs), and four states plan to include APMs in their MCO model in the future (see State-By-State Analysis Of Medicaid MCO Requirements For Provider Alternative Payment Reimbursement).
Additionally, there are over 12 million Medicaid enrollees in care coordination programs ranging from patient-centered medical homes (PCMHs), health homes, specialty carve-out health plans, and dual demonstration projects (see 2016 Medicaid Enrollment In Care Coordination Initiatives).
At the same time, we’ve seen the growth of ACOs. There are now over 750 public and private ACOs in all 50 states – 460 Medicare ACOs, 316 commercial ACOs, and 62 Medicaid ACOs. Currently, 67% of Americans live in an area with ACO coverage and 23.5 million Americans (seven percent of the population) receive care through ACOs (see The 2016 OPEN MINDS Medicaid ACO Trend Update and The 2016 OPEN MINDS Medicare ACO Update: A Three-Year Trends Report).
Those are the national initiatives and overview stats, but what does it look like at the individual provider organization level? The OPEN MINDS 2017 Performance Management Institute survey shows that in 2017, 41% of health and human services provider organizations are participating in value-based reimbursement arrangements. Of these, the majority are utilizing a pay-for-performance (P4P) fee-for-service (FFS) arrangement.
And this is reflected in the slow but steady movement of health plan financing to value-based arrangements. For example, in his keynote presentation, Brian Wheelan, Chief Strategy Officer and Executive Vice President, Beacon Health Options, outlined a move to APM models and the Beacon Health Options geographic footprint.
For more, the full survey results are available now for elite-level OPEN MINDS Circle members – 2017 OPEN MINDS Performance Management Survey: Where Are We On To The Road To Value?. The survey includes information on the number of organizations with non-governmental private contracts, the number of organizations with value-based purchasing arrangements, the percent of revenue tied to value-based purchasing arrangements, and an analysis of the challenges organizations are facing as they manage performance.
And for even more, Elite-level OPEN MINDS Circle members can join us on June 29, 2016 at 1:00 pm (EST) for an exclusive webinar, Where Are We With Value-Based Purchasing? An Executive Update, led by OPEN MINDS Chief Executive Officer, Monica E. Oss. For more coverage of the latest market intelligence on value-based care, follow me on Twitter – @.