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The Transition to Value-Based Care: Barriers to Risk Remain

Posted by The CareSync Team

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Jan 6, 2017 10:10:51 AM

AMGA members feel there are still significant barriers to risk.In its 2nd annual survey on taking risk, the AMGA asked its members about the transition to value-based care and if obstacles to taking risk remain. The survey revealed AMGA members, which include multispecialty medical groups and integrated systems of care, feel there are still significant barriers to risk, including limited access to claims data, risk-based insurance contracts, and investment capital.

Impeding Success

According to the AMGA, 58 percent of its members say they are ready to embrace alternatives to fee-for-service payments, including downside risk, within a few years, but 64 percent report there are no or limited commercial value-based or risk-based products available to them.

In addition, members cited issues with:
  • Getting administrative claims data from all payers. Without complete information, providers have difficulty effectively managing quality and cost.
  • Having to submit data in different formats to different payers, which creates administrative burdens.
  • Limited access to capital, which may delay investment in the infrastructure needed to take on risk, and can drive consolidation.

We need to bridge the gap between healthcare and Congress.Suggested Reform

To help remove these barriers and provide the resources necessary to succeed in a value-based payment model, the AMGA has offered the incoming Trump-Pence Administration and Congress several recommendations.

These include asking Congress to:  
  • Require federal and commercial insurance companies and providers to standardize data submission and reporting processes, and give healthcare providers access to all administrative claims data.
  • Create a fund that allows providers to use income on a tax-free basis to invest in taking downside risk.
  • Do the following to help support the success of Advanced Alternative Payment Models (Advanced APMs) under MACRA (the Medicare Access and CHIP Reauthorization Act of 2015):
    • Not penalize Advanced APMs if there are insufficient risk products in their local markets
    • Allow Medicare Advantage revenue to count in payment year 2019 toward meeting the Advanced APM revenue threshold
    • Allow Track 1 ACOs to be eligible as Advanced APMs

For more information, a white paper detailing the results of the 2016 risk survey is available on the AMGA website at www.amga.org/risk2wp.

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