Advancing value-based care: AMA, AHIP and NAACOS team up to launch new playbook

Value-based health care offers, in theory, an alternative form of health care delivery that would provide higher quality care at lower cost to those footing the bill. Putting VBC into practice has been a different story. Now, a collaboration of three major organizations has launched a campaign to address the barriers that have so far clipped VBC’s wings.

AHIP, the American Medical Association (AMA), and the National Association of ACOs (NAACOS) unveiled their barrier-busting strategy recently with the release of a playbook designed to work VBC adopters over and under the obstacles. The playbook–The Future of Value-Based Care and Payment–went public with the support of a half-hour webinar devoted to the first phase of implementation: data sharing.

In an introduction to the session, the three partners said:

“The first phase of this effort focused on data sharing as a fundamental building block of VBC operations. Together, the partners seek to advance the adoption of VBC in a manner that eases participation by creating an appropriate foundation to allow for alignment. By sharing what works, health insurance providers, physicians and other health professionals, hospitals, and VBC entities will have access to best practices that are informed by real-world experiences of participating practices to consider during the future design, implementation, and evaluation of their own VBC participation.”

Webinar presenters included Danielle Lloyd, Senior Vice President, AHIP; Carol Vargo, Vice President of Practice Sustainability, AMA; and Aisha Pittman, Senior Vice President, NAACOS.

As noted by the presenters, without efficient and as-seamless-as-possible data sharing, VBC will not be adopted by most of those who would benefit from it. Taking pages from the playbook, the webinar introduced five steps required to overcome the challenges of data sharing among VBC participants.

1. Adopt consistent content and exchange standards to simplify and expand data sharing. Lloyd said the challenge here is to create systems that speak the same language and interface smoothly. All participants in the VBC network must be able to “ingest and understand the information. There are steps along the way we need to take to pitch and catch it, and analyze and act on it.” Currently, standardized data sets and exchange systems do not exist to the degree required. Many of the potential participants–especially standalone clinics–”are not sufficiently mature” in these areas to be able to benefit from the efficiencies of VBC.“ Aggregating across electronic health systems can be difficult. We will offer resources for standards and operating rules” so the partners can share easily with one another.
2. Empower participants with complete, accurate and consistent data that paints a more comprehensive picture of a patient. Currently, achieving equitable care that takes into account social determinants of care is hard to achieve due to gaps in data collection and accuracy. Data updating policies vary and can cause inaccurate data to arrive at the point of service. “The lack of integration there was really something that got in the way of our collective [pandemic] work,” Lloyd said. “So how do we share at the individual and population levels? A challenge here that came up is patient matching. We need to know we are sharing the right data with the right organizations in a timely fashion.”
3. Collect and share data to identify and address health disparities as well as barriers to care. Here, a lack of uniformity in privacy and transparency policies can thwart efforts to address health care inequities and to be able to address social determinants of health. As the partners approach this sensitive and complex area, they are establishing best practice for data collection and sharing that protects patient privacy while reducing health disparity and SDHs. “There will be new challenges as we connect with other organizations that are not using the same standards and definitions,” Lloyd said. “There’s a lot of work in the standards area that needs to be done here.”
4. Prioritize sharing focused insights and data early, often and in accessible ways, to improve care. NAACO’s Pittman said that information “must be presented so it can be leveraged to make decisions. It needs to be available at the point of care. It must be timely, it must be updated, and in standard formats in which data are shared. It has to be nimble and meet the varying needs of the participants. For instance, some participants can analyze raw data,” while others cannot process it and prefer to receive data in dashboard format. The playbook partners intend to support systems and data integration with training, and assist participants in leveraging existing data networks.
5. Share detailed information on how and what data were derived from to foster trust among participants. In order to achieve this goal, Pittman said there must be “transparency in all aspects of the arrangement” among collaborating parties. “We will establish benchmarks, sharing performance data, [and] information on data calculations.” Workarounds will need to be developed in cases where a party refuses to transparently share data with others in the VBC loop.

Pittman also pointed to the investment that will be required of VBC participants. “Participation will require an upfront investment–to the extent they are not aligned, that can increase cost. The key to scaling is recognizing this.”

Related: Alliance calls on Congress to advance value-based care

During a brief Q&A following the webinar, Pittman said the AHIP/AMA/NAACO partnership is determined to build on interest shown in VBC during the pandemic. The playbook represents their formal initiative to bring standardization to the market so that it can attract more clinicians into the fold.

“The turbulence in payments [that occurred during the pandemic] is causing folks to look at value arrangements as a way to stabilize payments. Now, there is a need to highlight best practices and move to more standardization when possible,” she said.

Vargo said VBC offers struggling standalone clinics as an alternative to being acquired by a larger entity, many of whom “aren’t even necessarily interested in [health care] value.”

She said VBC can offer practices as a way to remain independent and deliver higher quality care.

“This is really important for what we’re trying to do to shore up practices so they are capable of entering these [VBC] arrangements … Our goal is to ensure that physician practices are able to … stay independent if they want to, and are able to participate in [VBC] networks because some of the consolidation issues we are seeing are troublesome.”

But, she said, physician practices need the infrastructure to be able to participate in VBC networks. Many still don’t have the infrastructure necessary to collaborate. “What we are talking about today is key to that: data analytics. That will help physicians think about how they can get on that onramp if they are not already on that onramp [to a VBC arrangement].”

The next phase in the three partners’ playbook: addressing payment issues – another factor that plagues many independent clinics and drives them into the arms of acquirers.