Large healthcare companies work together on best practices

The rapid proliferation of value-based healthcare has left many healthcare professionals feeling a bit like engineers designing an airplane while they fly it.

“Over the past decade, value-based care has gone from virtually nonexistent to an undeniably important aspect of our health care system,” said Clif Gaus, president and CEO of the National Association of Accountable Care Organizations. “Today, for example, accountable care organizations alone account for 20% of Medicare benefits.”

Danielle Lloyd, senior vice president of market innovation and quality initiatives at AHIP, explained the purpose of the playbook: “Everything is changing so quickly that we wanted to step back, evaluate the lessons learned so far and take a fresh look at developing best practices based on real-world experience so that we can develop sustainable models for the future,” she said. “These are not policy recommendations, nor are they empty words. This is real, experience-based, actionable information.”

Although the handbook recognizes that there is no universal recommendation for value-based care arrangements, the voluntary best practices it contains are based on the direct experience of physicians, value-based care organizations, and health insurers. The findings are organized into seven areas:

• Payment allocation: Determine which physicians or facilities are held responsible for which patients and their associated medical costs.
• Benchmarking: Setting financial goals to compare with spending in a given year.
• Risk adjustment: Consideration of the relative disease state of patients.
• Influence of quality performance on pay: Rewarding companies for high-quality performance based on a set of metrics.
• Levels of financial risk: Assume some degree of financial responsibility, when and where appropriate, to improve outcomes and patient costs.
• Time and accuracy of payment: Structuring how and when funds flow into agreements.
• Incentives for the performance of participants in value-based care practices: Consider how to train and reward participants for achieving payment agreement goals.

An advisory working group composed of members of each association conducted interviews with subject matter experts.

“Addressing recent challenges in expanding value-based care arrangements requires intentional and sustained collaboration across the system,” said Mike Tuffin, president and CEO of AHIP. “This partnership among key stakeholders brings to the forefront voluntary best practices for aligned models that can streamline operations and build resilience to expand access to high-quality, equitable and affordable value-based care.”

Participants were selected to include a diverse cross-section of individuals with varying levels of experience implementing value-based care models. These included national and regional health plans, large, small, rural, integrated and independent physician practices, and value-based care organizations such as Accountable Care Organizations. With this diversity in mind, voluntary best practices were developed with a focus on the specific needs of rural communities and improving health equity for underserved populations.

“Our resources are limited and we need to be able to care for our population, allocate resources to them and know who we are caring for,” says Francis Mercado, chief medical officer of the Franciscan Medical Group.

“That’s a fundamental question that’s not easy to answer. What I like about this playbook is that it goes through all the different options and discussions you can have with your partners.”

To help patients achieve good health outcomes in these models, it is critical to properly implement key aspects of value-based payment, said AMA President Dr. Jesse M. Ehrenfeld.

“This handbook reflects the contributions of physicians from a range of practice settings on their experiences with patient allocation, financial risk and benchmarking,” he said. “It will be a valuable resource for both those with experience in value-based care and those just getting started.”