In 2022, 40.6% of healthcare dollars were in fee-for-service arrangements with no link to quality or value, similar to 40.5% in 2021. In 2022, 24.5% of dollars were spent in two-sided risk arrangements, up from 19.6% in 2021. The remaining 35% of dollars were spent in fee-for-service arrangements with links to quality or models with upside-risk only.
Overall, 36.1% of covered lives in the report were in value-based payment arrangements.
Value-based models were least common among commercial plans, where 54.5% of dollars were spent in fee-for-service arrangements with no links to quality or value. In Medicaid, 50.1% of dollars were spent in FFS arrangements. Risk-based models were most common in Medicare plans — in Medicare Advantage, 38.9% of dollars were spent in two-sided risk models, and 30.2% were spent in two-sided risk in traditional Medicare.
The report used data from 64 health plans and CMS data representing all traditional Medicare beneficiaries, accounting for 87% of the insured population in the U.S.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.