2023 Measurement Effort
The LAN launched the 2023 Measurement Effort to collect 2022 APM data on May 22, 2023, and the data collection period concluded on July 31, 2023. All seven LAN APM Measurement Efforts requested health plans and states to provide retrospective data of actual dollars paid to providers during the previous calendar year (CY) or the most recent 12-month period for which the data was available.
A total of 64 health plans, four FFS Medicaid states, and Traditional Medicare participated in the 2023 Measurement Effort, representing approximately 263,621,410 or 86.7% of the national market. The percentage of the national market is based on a denominator of approximately 304,000,000 lives covered by any health insurance plan.
The LAN used metrics to determine the extent of APM adoption, asking health plans and states to report dollars paid in CY 2022 or in the most recent 12 months for which it had data:
- Medicare Advantage had 57.2% of health care dollars in Categories 3 and 4, and 38.9% were in two-sided risk APMs (Categories 3B and 4).
- Traditional Medicare had 48.9% of health care dollars in Categories 3 and 4, and 30.2% were in two-sided risk APMs (Categories 3B and 4).
- The Commercial line of business had 34.6% of health care dollars in Categories 3 and 4, and 16.5% were in two-sided risk APMs (Categories 3B and 4).
- Medicaid had 40.2% of health care dollars in Categories 3 and 4, and 18.7% were in two-sided risk APMs (Categories 3B and 4).
Publication date: October 30, 2023
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 30, 2023
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, 67 health plans, four 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.