2019 Measurement Effort

The 2019 HCP-LAN APM Measurement Effort includes data from the HCP-LAN survey, surveys fielded by America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA), and Traditional Medicare. Conducted from May to July 2019, the survey process collected data from 70 participants, accounting for nearly 226.5 million Americans, or 77%, of the covered U.S. population. The data reflects payment activity in calendar year 2018. Health plans, states, and Traditional Medicare reported the total dollars paid to providers according to the LAN’s Refreshed APM Framework, which offers a common approach to classifying payment by category and subcategory. With this data, the LAN analyzed aggregate results by category and subcategory as well as by line of business: commercial, Medicare Advantage, Medicaid, and Traditional Medicare. The results show progress, with 35.8% of total U.S. health care payments tied to alternative payment models (APMs) in 2018, a steady increase from 23% three years ago.

The LAN APM Measurement Effort revealed the following for 2018 payments:

  • 39.1% of health care dollars in Category 1 (e.g., traditional fee-for-service or other legacy payments not linked to quality)
  • 25.1% of health care dollars in Category 2 (e.g., pay-for-performance or care coordination fees)
  • 35.8% of health care dollars in a composite of Categories 3 & 4 (e.g., shared savings, shared risk, bundled payment, population-based payments, integrated finance and delivery system payments)

These results highlight a continued move away from a fee-for-service system that reimburses only on volume, and towards patient- and value-centered APMs.

Publication Info

Publication date: October 24, 2019

31 pages

Suggested Citation: Health Care Payment Learning & Action Network. Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage, and Traditional Medicare Programs. October 24, 2019

The HCP-LAN invited health plans across market segments, as well as managed Medicaid FFS states, to quantify the volume of health plan in- and out-of-network spending that flows through APMs, including key areas of available pharmacy and behavioral health spending, if such data were available. Each of the questions in the survey corresponded to the categories and subcategories of the LAN’s Refreshed APM Framework, using the LAN survey tool, definitions, and methodology.

In this year’s effort, 62 health plans, 7 Medicaid FFS states, and Traditional Medicare participated; the measurement results were based on data combined across the LAN survey, the BCBSA survey, the AHIP survey, and Traditional Medicare. Health plans, states, and Traditional Medicare reported the total dollars paid to providers according to the LAN’s Refreshed APM Framework using the same survey questions and definitions. With this data, the LAN calculated aggregate results at the category and subcategory level as well as across lines of business.

For more information on the methodology, please read the Methodology and Results Report above.