process redesign, analytics, and
personnel to manage large populations of high-cost patients.
Additionally, many AMGA members are intentionally adopting a
value-based strategy to ensure
their place in evolving local markets.
There was significant sentiment
that medical groups had to move
to value on their own terms before
other players in the healthcare
sector developed additional risk
programs not well designed at the
provider level. Almost all commentators remarked that they felt
moving to value was better for the
patient, and caring for patients
was the reason most respondents
entered the healthcare field.
Impediments to Value
Similar to the past three surveys,
AMGA members report ongoing
obstacles in moving to value.
External impediments include a
lack of access to administrative
claims data from payers, lack of
structure a 3. 5 on the impediment
scale in 2015. By 2018, that score
had dropped to 2. 9. In the federal
setting, respondents scored physi-
cian compensation issues in 2015
as a 3.7. By 2018, that score had
decreased to 3. 2.
Scorings for external impediments, however, have remained
largely unchanged. For instance,
in 2015, respondents scored lack
of access to claims data as a 4. 3
in the commercial setting on the
impediment scale. In 2018, that
score actually increased to 4. 4.
In the federal setting, respondents
scored attribution methodologies
as 4. 4 as an impediment to risk. In
2018, respondents rated attribution
as a 4. 3.
Impediments to Value Insight
It appears that AMGA members
have been addressing impediments to risk that are within their
control (i.e., internal impediments).
Medical groups are investing in
Length of Time Before Accepting Downside Risk 2018
a uniform data submission and
reporting standard, multiple quality measurement programs, and
problematic financial benchmarking
and risk-adjustment methodologies,
particularly in the federal ACO program. Internal impediments include
building and financing the infrastructure necessary to take risk,
change management challenges,
and physician compensation issues.
When comparing survey responses
from 2015 and 2018, it appears
that medical groups are addressing
internal impediments to moving to
value. For example, in the commercial setting in 2015, insufficient
information technology (IT) infrastructure scored 3. 9 out of 5 as an
impediment to risk (with 5 being the
highest rating for an impediment).
In 2018, respondents scored that as
a 3. 1. Similarly, respondents rated
All Respondents MSMG IDS IDS +
Northeast Midwest South West 1–149 150–499 500–999 1,000+
< 1 year 38%
3 5 6 5 6 5 5%
Group Type Group Region Group Size (Physician FTE)