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Insights into Value-Based Care

Survey of primary care practices asked about participation in various value-based care models

  • 44% used fee for service payments with no links to quality
  • 46% said they receive revenue from one of two VBP models, either shared savings with upside or downside risk, or capitation/population-based payment models.

Source: Revcycle Intelligence

Another survey from the American Medical Association asked physicians whether they received any revenue from either FFS or APMs over time

  • In 2012, only 58% of physicians received any type of APM revenue, compared to 64% in 2022.
  • The percentage of all physicians surveyed who received FFS payments has slightly decreased over time and fluctuated by year.

Source: American Medical Association

The survey also asked physicians about their revenue sources from different payment types

  • 29% of physicians said they receive all of their revenue from FFS, and this number has gone down over time.
  • The percentage of physicians with some revenue from APMs has remained relatively steady over time, while the minority of physicians with no revenue from FFS has slightly increased from 2014.

Source: American Medical Association

The HCPLAN (Health Care Payment Learning & Action Network) measured US health care payments by category

  • FFS with no link to quality & value
  • FFS with some links to quality and value such as pay-for-performance
  • APMs built on FFS architecture (upside rewards and upside + downside risk for appropriate care)
  • Population-based payment with either A) condition-specific payments, B) comprehensive payments, or C) integrated finance and delivery System

Source: Health Care Payment Learning & Action Network

The Comprehensive End Stage Renal Disease (ESRD) Care Model (CEC) was the first Medicare ACO model that focused on a specific population

  • The model ran from 2015-2020
  • 7 dialysis organizations participated: Fresenius, DaVita, Dialysis Clinic, Inc, Rogosin, Atlantic, Centers for Dialysis Care, and Northwest Kidney Care.
  • 1,290 facilities participated in the last year, accounting for 17% of the total amount of dialysis facilities in the U.S.
  • 62,501 Medicare beneficiaries participated in the program.

Source: Centers for Medicare & Medicaid Services

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