The health care industry is struggling to move on value-based care, and many wonder what the future will look like. But while progress is slow, Medicare is moving toward risk. Commercial risk is the wild card. Because of this, the future of commercial risk will decide if the industry lives in a hybrid state forever or realigns around a new cost and quality standard.
Our team analyzed a robust database of commercial claims with nationwide coverage.
Within the data set, we focused on professional (non-facility) claims to identify the outpatient and ambulatory sub-service lines with the highest spending for commercial patients under age 65 in CY 2019.
Our team identified the primary procedure or service performed on each claim and attributed that claim to the corresponding sub-service line. We used average, price-normalized commercial rates reported at the claim level as a proxy for cost and spending.