Stakeholders Seek Ways to Accelerate Risk Sharing in MA

Although Medicare Advantage is outpacing other payer types in the move from volume to value, there are still ways the program could hasten the shift to value-based care, experts agreed during a recent panel of the AHIP 2022 National Conference on Health Policy and Government Programs. These range from the increased use of Z-codes to document social determinants of health to the adoption of a Star Ratings measure that would influence more risk sharing between MA organizations and their providers.

According to the Health Care Payment & Learning Action Network survey, which is conducted in partnership with AHIP and the Blue Cross Blue Shield Association, 58% of MA payments to providers in 2020 were through an Alternative Payment Model (APM) such as the Shared Savings Program or an episodic/bundled care payment model, and 29.3% of such payments were for a risk-bearing arrangement. That’s compared with nearly 43% of payments through APMs in Traditional Medicare and roughly 35% in both commercial and Medicaid plans.

© 2022 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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