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Accountable Care Task Force Outlines Rules for Value-Based Care

By Jennifer Bresnick

- The newly inaugurated Health Care Transformation Task Force (HCTTF) is wasting no time in getting HHS Secretary Sylvia Burwell’s accountable care goals off the ground.

Just days after Burwell’s pledge to significantly increase value-based reimbursement across the healthcare system, HCTTF has released nine principles for accountable care that can help guide the industry towards engaging in the organizational transformation necessary for the transition to outcomes-based payments.

Identify and quantify the patient population

“Efforts to meet the Triple Aim are enhanced when an ACO works with an identifiable patient population,” the guidelines say. In order to establish that population, ACOs should encourage patients to pick a healthcare organization from which they wish to receive care, and provide a way for patients to attest to their choice.  ACOs may wish to divide up patients based on where they have previously received care, then notify patients of the opportunity to acknowledge that care provider as their primary medical home.

Establish quality metrics that can be used for accountability and improvement

Payers and ACOs must work together to establish quality metrics that will be used to determine outcomes-based payment.  “Quality measurement policies and design should create an explicit business case for practicing continuous quality improvement rather than being treated as an initiative, extraneous to the everyday operations of the organization,” HCTTF writes.

“Essential to creating such an environment is ensuring that all measures that directly affect provider payments be exclusively based on outcomes and be uniform across all payers, both public and private, and all populations such that quality efforts can truly become an integral part of the provider’s work flow.”

ACOs must exhibit the ability to meet clinical, claims-based, patient experience, and patient reported quality measures.  The metrics must be comprehensive enough to accurately gauge performance but simple enough not to interrupt workflow or unduly burden providers with data collection.

Align quality measurement across multiple domains

The three domains of measurement for reimbursement, public accountability, and patient engagement must work together to establish consistent reporting structures that produce useful reporting and evaluation.  Adopting nationally accepted quality metrics may ensure that measures are properly coordinated.

Measure improvement in addition to comparing performance industry-wide

Quality metrics should not only compare performance against national benchmarks or other peers, the guidelines suggest.  They should also reward improvement over a provider’s own baselines.  “Extra emphasis should be given to reward groups that are able to disproportionately improve conditions and provide high quality care for traditionally disadvantaged populations,” the outline adds.

Provide incentives to ACOs that deliver results

Accountable care organizations aren’t just about taking on risk.  Financial incentives are also part of value-based arrangements, and should be delivered to organizations that contribute to the development of effective care quality measures and best practices.

Develop a simplified financial model

“Financial models should use simple, open-source methods and codes that allow for replicability,” HCTTF says. Developing a dual track for financial models – one based on historical claims for high cost providers, and the other based on community ratings and health status improvement – can encourage participation for a range of different providers.

Support ACOs as they take on financial risk

As accountable care organizations mature to the point of taking on financial risk, they will need better tools to provide high quality care.  Clinical decision support can help providers make shrewder choices for high-cost patients, while adjustments to underlying payment structures can ease the transition into risk sharing.

Ensure consistent access to performance and outcomes data

Population health management and accountable care rely on access to patient data that help to understand the needs of an individual patient or the community at large.  ACOs that are serious about managing populations and providing individualized care must ensure timely access to up-to-date data analytics in order to succeed.  HCTTF suggests that the vendor community strive to lower the price barrier for their customers, who must work with stakeholders across the healthcare continuum to ensure data interoperability and useful reporting.

Support the journey towards programs that help meet the Triple Aim

Finally, the industry must attempt to involve as many providers as possible in the journey towards value-based accountable care by reducing the financial burden of adopting infrastructure, encouraging organizations to take on risk-sharing, and providing attractive financial incentives for doing so.  With industry-wide engagement, healthcare providers will be able to improve outcomes, boost patient engagement, and reduce costs in pursuit of the Triple Aim.




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