2024 Measurement Effort
The 2024 HCPLAN Measurement Effort launched in May 2024 and concluded at the end of July 2024. Health plans, states, and Traditional Medicare provided retrospective data on actual dollars paid to providers and total lives covered in accountable care arrangements during calendar year (CY) 2023 or the most recent 12-month period for which the data was available.
A total of 73 health plans, four fee-for-service (FFS) Medicaid states, and Traditional Medicare participated in the 2024 HCPLAN Measurement Effort representing almost 282.9 million, or 92.7% of people covered by an insurance plan in the commercial, Medicare Advantage, Medicaid, or Traditional Medicare lines of business.
The HCPLAN used metrics to determine the extent of APM adoption, asking health plans and states to report dollars paid in CY 2023, or in the most recent 12 months for which they had data:
- Medicare Advantage had 64.3% of health care dollars in Categories 3 and 4, and 43.0% were in downside risk APMs (Categories 3B and 4).
- Traditional Medicare had 42.0% of health care dollars in Categories 3 and 4, and 33.7% were in downside risk APMs (Categories 3B and 4).
- The Commercial line of business had 39.2% of health care dollars in Categories 3 and 4, and 21.6% were in downside risk APMs (Categories 3B and 4).
- Medicaid had 43.7% of health care dollars in Categories 3 and 4, and 21.1% were in downside risk APMs (Categories 3B and 4).
Publication Info
Publication date: November 14, 2024
35 pages
Suggested Citation: Health Care Payment Learning & Action Network. APM Measurement: Progress of Alternative Payment Models, 2024 Methodology and Results Report. November 14, 2024
The HCPLAN 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. Each of the questions in the survey corresponded to the categories and subcategories of the HCPLAN’s Refreshed APM Framework, using the HCPLAN survey tool, definitions, and methodology.
In this year’s effort, 73 health plans, four Medicaid FFS states, and Traditional Medicare participated; the measurement results were based on data combined across the HCPLAN survey, the BCBSA survey, the AHIP survey, and Traditional Medicare data provided by CMS. Health plans, states, and Traditional Medicare reported the total dollars paid to providers according to the HCPLAN’s Refreshed APM Framework using the same survey questions and definitions. With this data, the HCPLAN 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.