---
type: source
title: "HCPLAN 2024 Annual Survey: Full Capitation Doubled to 14%, 28.5% of Payments in Downside Risk APMs"
author: "Health Care Payment Learning & Action Network (HCPLAN)"
url: https://hcp-lan.org/2024-infographic/
date: 2025-09-01
domain: health
secondary_domains: []
format: report
status: processed
processed_by: vida
processed_date: 2026-04-29
priority: high
tags: [value-based-care, payment-reform, full-risk, capitation, downside-risk, APM, HCPLAN, belief-3]
intake_tier: research-task
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

The Health Care Payment Learning & Action Network (HCPLAN) 2024 annual survey measured APM adoption across 73 health plans, 4 FFS Medicaid states, and Traditional Medicare — representing 282.9 million covered lives (92.7% of all insured Americans).

**Key statistics:**
- **Full capitation (Category 4):** ~14% of all US healthcare payments — DOUBLED from 7% in 2021 (4-year timeframe)
- **Downside risk APMs (Category 3+4):** 28.5% of US healthcare payments — up from 24.5% in 2022
- **Accountable care arrangements:** 88.5 million lives in Categories 3+4 combined

**Trend context (from broader research sources):**
- 2021: 7% fully capitated
- 2022: 24.5% in downside risk
- 2024: 14% fully capitated, 28.5% in downside risk
- CMS 2030 goal: all Medicare FFS beneficiaries in accountable care relationship

**CMS policy acceleration:**
- 2026 final rule: making two-sided risk the "organizing principle" for Medicare payment
- New mandatory Ambulatory Specialty Model (ASM): heart failure and low back pain
- MSSP: reducing time allowed in one-sided risk from 7 to 5 years (starting 2027)
- REACH Model: full risk option — 100% of savings or losses

**Trump administration position:** Supporting ACO expansion and pushing for MORE downside risk adoption to generate savings from MSSP programs.

## Agent Notes

**Why this matters:** Provides the quantitative trend line for VBC structural transition — the core measure of whether Belief 3's "transition is slow but real" is tracking correctly. Full capitation DOUBLING in 4 years (7% → 14%) is more meaningful than the absolute 14% figure.

**What surprised me:** The Trump administration's PRO-VBC stance. The KB narrative has been that VBC transition faces political headwinds, but the Trump administration is actively pushing for MORE downside risk adoption to generate Medicare savings. The structural transition has bipartisan momentum at the federal level.

**What I expected but didn't find:** Evidence that the MA market disruptions (UHG losses, Humana exits from markets) are slowing the broader VBC trend. The HCPLAN data covers ALL insurance, not just MA — so the MA distress doesn't dominate the overall picture.

**KB connections:**
- Directly measures the transition described in [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]] — the 14% full-risk figure is now updated (14% capitated, 28.5% downside risk)
- The ~50% full-risk threshold mentioned in Vida's identity.md as the tipping point is still far, but doubling in 4 years shows credible trajectory
- Connects to [[the healthcare attractor state is a prevention-first system...]] — this is the mechanism of transition toward that attractor

**Extraction hints:**
- UPDATE CLAIM: The existing "14 percent bear full risk" figure needs updating — it's now 14% FULLY CAPITATED (up from 7% in 2021), with 28.5% in any downside risk APM. The original claim's framing ("only 14 percent bear full risk") is still roughly accurate numerically but the trend direction matters: it has doubled.
- NEW CLAIM: "Full capitation in US healthcare doubled from 7% to 14% between 2021-2025, with CMS policy actively accelerating the shift to two-sided risk as the default payment model — suggesting the VBC structural transition is accelerating despite its slow absolute pace"
- The absolute/relative tension: 14% full-risk is still low in absolute terms but the doubling rate and CMS policy direction suggest it's not stagnating.

**Context:** HCPLAN measures the broadest available population (92.7% of covered lives). Most authoritative VBC adoption data in the field. Annual survey, 2024 results.

## Curator Notes

PRIMARY CONNECTION: [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
WHY ARCHIVED: Provides updated quantitative data for the VBC adoption rate claim. The existing claim should be enriched with trend data (7% → 14% doubling). CMS policy acceleration is the structural driver.
EXTRACTION HINT: Two extraction opportunities: (1) enriching the existing VBC transition claim with updated trend data, and (2) potentially a new claim about the VBC transition acceleration rate and CMS policy direction.
