Alternative Payment Models

In 2016, 29% of total U.S. health care payments were tied to alternative payment models (APMs) compared to 23% in 2015, a 6% increase. 
This is reported by Health Care Payment Learning & Action Network (LAN),launched in March 2015 by the U.S. Department of Health and Human Services, convenes the public, private, and non-profit sectors to drive adoption and alignment of APMs with a target to push APMs to 50% by 2018. https://hcp-lan.org/groups/apm-fpt-work-products/apm-report/
Data is based upon coverage of 84% of lives or 245 million people. 43% are still covered by traditional fee for service (FFS) plans or in Category 1.
28% of health care dollars are paid through Category 2 or pay-for-performance or care coordination fees. A major shift has occurred to this catgeory from FFS.
Finally, 29% of health care dollars paid out in Categories 3 and 4 or shared savings, shared risk, bundled payments, or population-based payments. This category accounts for payment of approximately $354.5 billion dollars nationally.

Meanwhile, the number of ACOs in 2016 was about 474 compared to 404 in 2015 and 353 in 2014.MACRA is projected to accelerate the trend towars physicina employment by large practices or health systems.
A survey of healthcare CEOs indicates their view: 91% see continued growth in the employment area,  73% see increased stress for physicians (surprised?), 52% see more practices taking on risk based contracts and 42% see more physicians leaving Medicare.

Comment: And by the way, healthcare costs are now projected to bump up to 6.5% in 2018 from a steady 6% or less. (Source PWC data) For ordinary people, From 2011 to 2016, the average health premium for family coverage purchased through an employer rose 20 percent. In the same period, wages increased just 11 percent.

For physicians, the stress continues to rise. Burnout rates are up to 50%. Pressure to cut out 'low value' services is on. Physicians indicate fears of malpractice, patient demand and satisfaction, concern about missing an underlying, serious diagnosis still exist with no relief in sight.
A Harvard Business Review article recently suggests a link betwen Work Life balance and what you saw your parents do!!
Be sure to read this.
https://hbr.org/2017/10/your-feelings-about-work-life-balance-are-shaped-by-what-you-saw-your-parents-do