Chet Speed
(703) 838-0033 ext. 364

17 September 2015

AMGA 2015 Medical Group Risk Survey Finds Members Are Transitioning to Risk-Based Payments, but Significant Impediments Exist

Alexandria, VA – September 17, 2015 – The American Medical Group Association (AMGA) today announced that multispecialty medical groups (MSMGs) and integrated delivery systems (IDSs) expect fee-for-service payments to decline by 24 percent over the next two years, yet barriers are slowing the transition to value-based care according to results from a new survey.

There has been much discussion focused on the need for risk- or value-based payments among policymakers, yet there has been much less discussion on how to actually achieve that value.

AMGA’s survey found that among commercial insurers, a lack of access to administrative claims data, a lack of transparency into cost and quality data, and ineffectiveness of attribution methodologies rated as the highest areas of concern. Concerns with Federal programs included ineffective attribution, benchmarking and risk-adjustment methodologies, followed by the lack of a standardized data submission and feedback processes. While both financial and data issues were included, data issues were perceived as more significant.

Respondents also noted a lack of risk offerings from insurers in their local markets, preventing them from being able to take the necessary risk. Twenty-two percent of survey respondents indicated that no insurers were offering risk-based products in their market, while 48 percent stated that only 1-to-19 percent of insurers were offering risk-based arrangements in their market.

The survey also showed that 41 percent of respondents needed between three to five years before they could accept downside risk, while 17 percent stated they needed more than six years to accept downside risk. This demonstrates that transitioning to risk may take longer than policymakers anticipate.

Results show revenues from commercial Accountable Care Organizations (ACOs) and partial- and full- capitation arrangements are expected to double by 2017. Revenues from Federal value-based arrangements such as ACOs and Medicare Advantage are expected to grow between 20 and 36 percent. These payment changes are occurring as Congress and the Department of Health and Human Services (HHS) are embarking on an ambitious plan that essentially mandates providers accepting payment risk over the next several years. 

Importantly, the survey also detailed tools that the Federal government and commercial payors can offer providers to accelerate the transition to risk-based payments. Access to administrative claims data, improved data transparency and data exchange processes, and improved attribution, benchmarking, and risk-adjustment methods will help providers, payors, and patients succeed in a new value-based payment system.

“Our members understand the importance of transitioning to a value-based payment system, in fact many are already moving in that direction,” said Chester A. Speed, JD, LLLM, Vice President, Public Policy at AMGA. “This transition will be challenging and medical groups need policymakers and commercial insurers to partner with them to offer the tools they need to be successful in a new risk environment. We at AMGA look forward to working with Congress, HHS, and the commercial sector to implement the strategies that will drive success in a value-based healthcare system.”

The AMGA 2015 Medical Group Risk Survey presents data received from 115 respondents representing 101 AMGA-member medical groups throughout the U.S. The data includes breakdowns by organization structure, group size, and geographical region. Respondents included small to large MSMGs with health plans (5 percent) and without health plans (43 percent), as well as IDSs with health plans (15 percent) and without health plans (37 percent).

For more information about the survey results, click here.

About the American Medical Group Association
The American Medical Group Association is a 501(c)(6) trade association representing medical groups, health systems, and other organized systems of care, including some of the nation's largest, most prestigious integrated delivery systems. AMGA is a leading voice in advocating for efficient, team-based, and accountable care. AMGA members encompass all models of organized systems of care in the healthcare industry, including: physician-owned, independent group practices, integrated delivery systems, hospital-affiliated medical groups, independent practice associations (IPAs), academic and faculty practices, accountable care organizations, and high-performing health systems. More than 170,000 physicians practice in AMGA member organizations, providing healthcare services for 120 million patients (one in three Americans). Headquartered in Alexandria, Virginia, AMGA is the strategic partner for these organizations, providing a comprehensive package of benefits, including political advocacy, educational and networking programs, publications, benchmarking data services, and financial and operations assistance.