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Value-based programs have a triple aim: better care for patients, better health for populations and lower cost of health care, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
By 2030, CMS has a goal of 100% of Traditional Medicare beneficiaries and a vast majority of Medicaid beneficiaries participating in accountable care relationships. There are plenty of patients. Taken together, Medicare and Medicaid enrollees are approaching 40% of the American population, depending on the measure, and there is always demand for health care. There is plenty of money, at least in theory. Medicare spending hit $1 trillion in 2023 or 21% of the nation’s total health care spend.
Yet, after years of experimenting with payment models, physicians have been slow to get on board.
“Less than half of practicing primary care physicians are signing up for these models, and that’s really important to address this participation issue because resources are being invested in these models,” said Ann S. O’Malley, M.D., M.P.H., senior fellow at Mathematica. “A lot of resources are being invested in trying to evaluate whether they work. But if we’re not getting the bulk of primary care practitioners to participate in the models, it’s hard to really give them a full evaluation and know how well they work and how to improve them going forward.”