Health System Participation in Medicare Alternative Payment Models in 2018

Health System Participation in Medicare Alternative Payment Models in 2018

Published: Aug 23, 2021
Publisher: Mathematica
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Associated Project

Coordinating Center for Comparative Health System Performance

Time frame: 2016-2021

Prepared for:

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality

Key Findings
  • More than two-thirds of U.S. health systems participated in at least one Medicare APM during 2018.
  • Physicians affiliated with health systems were more likely to participate in Medicare APMs when compared with unaffiliated physicians.
  • Among health systems with physicians participating in Medicare APMs, a median of 80 percent of their affiliated physicians participated, although this varied considerably across systems and by APM type.

The Centers for Medicare and Medicaid Services are testing a number of alternative payment models that tie health care payments to higher value care. To characterize health system and provider participation in these alternative payment models (APMs) in 2018, we used data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems. We found that two-thirds of health systems had some physician participation in at least one Medicare APM during that year, and that a greater percentage of health system–affiliated physicians participated in a Medicare APM compared with physicians not affiliated with a health system. Future research should leverage the Compendium and other data sources to examine differences in APM participation across health care markets and by provider specialty type to identify areas for new payment reform efforts.

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