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Panel: Stable benchmarks, regional seeding and simpler entry paths needed to expand physician participation in value-based care
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Summary
Experts at a PTAC listening session said growth in accountable care and other population-based payment models has plateaued and urged clearer, more stable program design, market-focused seeding and simpler 'enablement' services to broaden participation beyond early adopters.
A group of clinicians, health-system leaders and policy experts told a PTAC listening session that expanding clinician participation in population-based total cost of care models will require more stable program rules, regional seeding strategies and easier paths for mainstream practices to join.
Speakers said the current pattern—strong early adoption by some primary care practices and stagnation thereafter—reflects program uncertainty, complex rules and lack of market-level initiatives to seed adoption.
"There has been very consistent growth" in qualified participation in Advanced Alternative Payment Models, "from 8% in 2017 to about 29% in 2023," said David Moulstein, chief executive officer of Simple Health Care, citing his analysis. But he and other panelists said ACO growth has plateaued with organizations joining and others exiting, and that participation varies widely by specialty and by state.
Why it matters: Panelists said broader participation is a prerequisite for many policy aims—improving outcomes, reducing unnecessary utilization and addressing equity gaps—and that simply offering more experimental models has not produced mainstream adoption.
Most of the panel’s practical recommendations focused on three themes: (1) stabilize and clarify the statutory programs that serve as the main pathway to total-cost models, (2) cultivate regional "seeding" efforts that create market momentum, and (3) make it easier for typical practices to join through so-called "simplifiers" or enablement partners that manage the technical work.
David Moulstein described structural trends he said are shaping provider readiness: physician practice consolidation, faster APM adoption among primary care clinicians than specialists, and growth of nonphysician clinicians (nurse practitioners and physician assistants). "When a market starts to move, all of the participants start to think about this, and they start to respond," he said, urging regional strategies that "seed the initial organizations that start moving to value based care."
Sanjay Shetty, president of CenterWell at Humana, said integrated assets and payment diversity supported his organization’s senior-focused strategy. CenterWell operates primary care centers, a home health agency and a pharmacy network, he said, and has combined those assets to pursue both Medicare Advantage and government APMs. Shetty referenced a Health Affairs analysis his organization published showing higher primary care utilization and lower emergency and inpatient use among senior-focused primary care patients: "we see better access—17% more primary care visits; 11% fewer ED visits; 6% fewer hospitalizations; and 10% fewer 30-day inpatient readmissions," he said.
Sean Cavanaugh, chief policy officer at Aledade, argued that the program design and the way it is presented matter to mainstream practices. "We've been very successful in engaging the early adopters," he said, but "the things that attracted the early adopters are very different from the things that will attract the mainstream market." He urged the committee and CMS to treat the Medicare Shared Savings Program (MSSP) as the "chassis for innovation," stabilize benchmarking and reduce sudden program changes, and actively market the opportunity to practices.
Panelists debated several design and operational issues raised in audience questions: whether outcome measures should supplant many process metrics (many panelists favored total cost of care plus outcomes rather than stand-alone process measures), how to account for specialists and nonphysician clinicians in APMs, and the technical pricing problems that arise when designing smaller, specialty-specific bundles.
Panelists also emphasized practical steps to enlarge participation: create clear, long-term program rules and benchmarks; allow local market experimentation and regional models rather than national mandates; endorse and accommodate enablement partners that reduce administrative burden for practices; and focus initial expansion efforts on primary care while developing specialty pathways.
The session moved to Q&A on measures, specialty engagement and operational details; the committee recessing for lunch before public comments.
