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Sharon Grace
Vice President, Public Relations
703.838.0033 ext. 393
sgrace@amga.org

December 13, 2017

Survey Finds Nearly 60% of Revenues from Medicare Will Be from Risk-Based Products by 2019
AMGA members expect Medicare Advantage revenue to match Medicare fee-for-service revenue

Alexandria, VA – AMGA member 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 and serve as an avenue to value-based reimbursement, according to the results from a recent survey. The findings stem from AMGA’s third annual risk survey, which examined how and when AMGA members are transitioning from reimbursements based on volume to payment models based on value. The survey also identified impediments to taking financial risk in insurance contracts.

The survey findings, detailed in a white paper, indicate that by 2019 AMGA members expect their revenues from Medicare Advantage to equal the payments from fee-for-service Medicare. Overall, if Medicare Advantage, bundled payments, Medicaid Managed Care Organizations, and Medicare Accountable Care Organizations (ACOs) are factored together, alternatives to Medicare fee-for-service (FFS) are predicted to account for 59% of AMGA member’s revenues by 2019, compared to 53% in 2017. Although Medicare Advantage plans largely remain fee-for-service-based, AMGA members report they consider the program to be a strategic priority and to serve as a gateway to more sophisticated risk models.

“Medicare Advantage is an increasingly popular option for beneficiaries,” said Jerry Penso, M.D., M.B.A., AMGA president and chief executive officer. “The program also represents an option for quite a few AMGA members to begin taking on financial risk, given the limited availability of other risk products.”

AMGA’s 2017 risk survey found that several, significant impediments to taking on risk remain. Like in previous surveys, AMGA members reported that data sharing issues, inadequate infrastructure, limited access to capital, and a lack of commercial risk products in their market present barriers to their taking on financial risk.

“AMGA calls on Congress and HHS to address impediments to taking risk and to create incentives for other industry players to engage in the risk market,” said Chester A. Speed, J.D., LL.M., AMGA’s vice president, public policy.

Despite these impediments, the transition to value is continuing. For example, survey respondents confirm that they continue to move away from FFS payments to some sort of risk-based payment model. Medicare FFS payments are expected to decrease by 17% by 2019, while commercial FFS payments will decline by 11%.

The commercial risk market, however, continues to lag behind federal programs. For example, 56% of respondents said they have little to no access to commercial risk products in their local markets. While more members have access to commercial products than reported in earlier surveys, commercial payers still largely are not offering risk-based products.

The survey noted that the respondents are moving to risk largely without the active participation of key players in the healthcare system. The white paper recommends federal policymakers address longstanding impediments to risk and create incentives for other parts of the industry to enter into value arrangements.

Please visit the AMGA website to download the risk white paper. The website also contains numerous resources related to Medicare Advantage and other risk-based models.

About the Survey
In 2015, AMGA first surveyed its members about transitioning from FFS to value-based payment models. AMGA repeated this process in 2016 and 2017 to assess member progress on the transition to value or risk. Respondents answered the survey between June and August 2017 via AMGA Survey Analytics. Eighty respondents from AMGA member groups began the survey, and 74 answered all of the questions.

About AMGA
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, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, visit amga.org