The general trend demonstrates a preference for structures with shared risk in the near term, with a gradual move toward assuming greater downside risk in the longer term.
When it comes to the assumption of risk in population health programs, particularly downside risk, providers continue to proceed with a high degree of caution. The stakes are too high to do otherwise. The general trend demonstrates a preference for structures with shared risk in the near term, with a gradual move toward assuming greater downside risk in the longer term.
For example, in the 2018 HealthLeaders Media Population Health Survey, respondents say that shared savings programs with payers (47%) and bundled payments (46%) are the top two financial risk structures their organizations currently use in caring for an identified population.
These results are nearly identical to last year's survey (48% and 47%, respectively), and are nearly double the results for risk structures with downside risk such as capitation (25%) and shared profit and loss with payers (24%).
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The responses for capitation and shared profit and loss arrangements with payers are also almost identical to last year's survey (25% and 23%, respectively), further evidence that respondents are reluctant to assume risk-sharing financial models with downside risk.
Looking to the future
Respondents say that shared savings programs with payers (54%, up seven percentage points) and bundled payments (54%, up eight percentage points) will remain the top financial risk structures their organizations use in caring for an identified population in three years.
However, the biggest gain in response for the results in three years is for shared profit and loss arrangements with payers (41%, up 17 percentage points), which moves to third position on the list of responses, up from fifth currently. This is a clear indication that respondents expect to assume greater financial risk in the next three years.
Frank E. Belsito, DO, MMM, chief physician executive, and chief population health officer at Metro Health – University of Michigan Health in Wyoming, Michigan, agrees and also points out that direct contracting with employers has the second-largest increase in response at 16 percentage points.
"We started doing direct contracting about seven months ago. I think if we can demonstrate consistent price controls for their healthcare costs and keep things reasonable for self-insured businesses and employers, you're going to see those numbers jump further," he says.
Affiliated with University of Michigan Health, Metro Health is an integrated health system that features a 208-bed acute care hospital and numerous outpatient locations throughout western Michigan.
"I believe health systems have to become the disrupters, not the disruptee, if you will. We need to be more disruptive about the care process and around population health," says Belsito.
Jonathan Bees is a research analyst for HealthLeaders.