WASHINGTON, D.C. – (October 30, 2023) – AHIP issued this statement as the Health Care Payment Learning & Action Network (HCP-LAN) released the results of its calendar year 2022 Alternative Payment Model (APM) measurement survey conducted in partnership with AHIP and the Blue Cross Blue Shield Association (BCBSA). The LAN survey is designed to understand how widely value-based care models are being adopted as health insurance providers, clinicians, hospitals, and health care systems work together to move from paying for volume to value. The results include the percent of provider payments and lives covered through APMs by line of business (LOBs)—Commercial, Medicaid, Medicare Advantage (MA), and original Medicare.
“At their core, value-based care models seek to maximize value for patients by achieving the best health outcomes at the lowest cost while improving the patient experience. To meet this goal, value-based care models move beyond ‘sick care’ and toward a proactive, coordinated, and data-driven approach that puts patients first and helps them get and stay healthy.
“Patients deserve a health care system centered around their needs and focused first and foremost on delivering affordable, evidence-based care that works. That’s why health insurance providers are committed to building innovative payment models and collaborative relationships to help all Americans thrive and reach their full health potential.”
Key Findings from the survey of 2022 data include:
- The survey reflects a strong majority (86.7%) of people who are covered in the U.S. This makes the survey an accurate measure of how many Americans are being cared for through value-based care arrangements. This is an increase from 77% in 2021 and demonstrates how the HCP-LAN survey represents the most comprehensive and robust evaluation of payer adoption of models.
- On average, 41.3% of responding payer payments flowed through advanced payment models (Categories 3-4) across all payer types. This demonstrates that value-based care not only weathered the COVID-19 pandemic but continues to make progress away from fee-for-service and toward value-based payment models across all categories.
- Participation in risk-based models increased in 2022, with nearly 1 in 4 (24.5%) of U.S. health care payments flowing through risk-based advanced payment models (Categories 3B-4), up from 1 in 5 (20%) in 2021. Participation in the most advanced models (Category 4) also increased from 7.4% in 2021 to 9.6% in 2022. Risk-based models embed a deeper level of accountability into value-based payment models.
- MA plans continue to lead the way, with 57.2% of payments flowing through any sort of advanced payment model, and 38.9% of payments flowing through risk-based advanced payment models. Such strong adoption indicates MA plans’ commitment to improved affordability and value.
- The 2022 results include, for the first time ever, accountable care data that shows the number of lives in accountable care arrangements for all lines of business. In 2022, 36.1% of the lives represented by data contributors were covered in accountable care arrangements, across all LOBs.
- Nearly all plans are leveraging value-based care arrangements to improve health equity, with 95.6% of plans reporting doing at least one health equity activity, including data collection, measuring or reducing clinical outcome inequalities, and completing staff competency training to serve diverse populations. For example, 46% are incentivizing providers to collect standardized race, ethnicity, and language data. Further, 37% are incentivizing screening for socioeconomic barriers through these arrangements.
- A strong majority - 93% - of payers believe advanced payment models will result in better quality of care and 79% believe these models will result in more affordable care.
The LAN APM survey is fielded with the support of AHIP and the BCBSA.
Click here to view the 2023 LAN APM survey.
Click here to view more AHIP Value-Based Payment and Care Delivery resources.
About AHIP
AHIP is the national association whose members provide health care coverage, services, and solutions to hundreds of millions of Americans every day. We are committed to market-based solutions and public-private partnerships that make health care better and coverage more affordable and accessible for everyone. Visit www.ahip.org
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