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.