Payment Transformation Update. As we look at the pace of the transition from fee for services to value or risk, we need to separate the line of business. For fee for service payment methodologies, we see:
- Medicare Advantage hovers at 48%
- Original Medicare moved to 11%
- Medicaid remains at 68%
- Commercial moved to 57%
If we want to move all the way across the spectrum of payment to population-based payments (global or premium risk), we note that:
- Medicare Advantage sits at about 10%
- Traditional Medicare uses this only 4% of the time
- Medicaid implements this approach 4% of the time
- Commercial moved to about 3% of the relationships
It may be important to note that across all payers 40% of the time the relationship is based on a traditional fee-for-service structure, while about 26% is pay for performance, 31% is structured in shared services or bundles, and finally 4% is population based payments such as percent of premium or global risk budgeting.