Medical groups slowly taking on more risk

Physician groups derived a larger share of revenue from payment models requiring them to take on risk in 2018 than in previous years, according to a survey by the AMGA.

The survey of 75 multispecialty medical groups, integrated delivery systems and independent physician associations showed that 56% of respondents' federal program revenue came from value-based payment models in 2018. That's up from 45% in 2015.

The shift toward value is moving more slowly in the commercial market. Medical groups reported that risk-based payments accounted for 28% of their total commercial revenue in 2018, an increase from 22% in 2015.

"When comparing survey responses from the 2015 and 2018 surveys, it is clear that AMGA members are moving to value," AMGA President and CEO Dr. Jerry Penso said in a statement. "AMGA members believe value-based models support their team-based, coordinated, data-driven model of care, which results in better patient outcomes."

Most of medical groups' federal value-based revenue in 2018 came from Medicare Advantage, with accountable care organizations and Medicaid managed care providing the rest. On the commercial side, most risk-based revenue came from shared-risk and shared-savings ACO arrangements. Medical groups reported little traction with bundled payments in the federal and commercial programs.

Survey respondents said they expect that by 2020, 64% of revenue from federal programs and 37% from commercial programs will be value-based. Obstacles that could prevent them from taking on more risk included lack of access to administrative claims data needed to manage large patient populations, as well as inconsistent data submission and reporting.

They also noted challenges with building and financing the infrastructure needed to take on risk and insufficient care management and data analytics.