New value-based care playbook: Major health care groups team up on best practices
The AMA, AHIP and NAACOS developed a resource guide on best practices to advance value-based care, which includes input from physicians on lessons learned for patient attribution, financial risk and benchmarking.
“In the last decade, value-based care has grown from almost nothing to an undeniably significant aspect of our health system,” said Clif Gaus, president and CEO of the National Association of Accountable Care Organizations. “Today, for example, accountable care organizations are 20% of Medicare alone.”
The association teamed up with America’s Health Insurance Plans and the American Medical Association to develop a playbook on voluntary best practices as part of their efforts to advance adoption of value-based care arrangements in the private sector. Leaders of the three organizations introduced the playbook, Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Practices for VBC Payment, during the NAACO spring conference.
Danielle Lloyd, senior vice president for market innovations and quality initiatives for AHIP, discussed the purpose of the playbook: “Everything is changing so fast that we wanted to step back, assess the lessons learned so far and take a fresh look at building best practices that are rooted in real-world experiences so we can inform sustainable models for the future,” she said. “These are not policy recommendations, and this is not a fluff piece. This is real-world, experience-based, actionable information.“
Although the playbook recognizes that there is no single best recommendation for value-based care arrangements, its voluntary best practices were derived from the direct experience of physicians, value-based care entities and health plans. The insights are organized into seven domains:
- Payment attribution: Determining which patients and associated medical costs for which physicians or entities are accountable.
- Benchmarking: Setting financial targets to compare to spending over a particular year.
- Risk adjustment: Accounting for the relative sickness of patients.
- Quality performance impact on payment: Rewarding entities for quality performance based on a set of metrics.
- Levels of financial risk: Assuming some level of financial responsibility, if and when appropriate, for improving outcomes and patient costs.
- Payment timing and accuracy: Structuring how and when funds flow in arrangements.
- Incentivizing for value-based care practice participant performance: Considering how to educate and reward participants in achieving the goals of payment arrangements.
An advisory workgroup comprising members from each association conducted interviews with subject matter experts.
“Overcoming recent challenges to the expansion of value-based care arrangements requires focused 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 resiliency to expand access to high-quality, equitable and affordable value-based care.”
Participants were selected to ensure a diverse cross-section of individuals with varying experiences in implementing value-based care models. including national and regional health plans; large, small, rural, integrated and independent physician practices; and value-based care entities, such as accountable care organizations. Voluntary best practices were developed with this diversity in mind, with a focus on specific needs of rural communities and advancing health equity for underserved populations.
“We have finite resources, and we have to be able to take care of and assign resources to our population and know whom we are taking care of,” said Francis Mercado, ambulatory association chief medical officer for medical specialties for the Franciscan Medical Group.
“It’s a fundamental question that is not easy to answer. What I love about this playbook is that it goes through all of the various options and discussion you can have with your partners.”
Getting important aspects of value-based payment right is crucial to helping patients achieve good health outcomes in these models, AMA President Dr. Jesse M. Ehrenfeld said.
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“This playbook reflects input from physicians in an array of practice settings on their lessons learned for patient attribution. financial risk and benchmarking,” he said. “It will be a valuable resource for both those with experience in value-based care and those who are just getting started.”