A growing number of care providers across the country are participating in value-based payment arrangements that are helping to transition the nation away from traditional fee-for-service methods of paying for health care. While fee-for-service models offer little accountability for health outcomes, more and more providers are using new models that reward their ability to deliver higher quality care with greater efficiency.
Accountable Care Organizations (ACOs) are a prominent example of value-based payment. Under these programs, groups of providers agree to assume responsibility for the total cost of care of a patient population while maintaining or improving quality, in exchange for the chance to share in any savings generated due to better care.
ACOs have spread rapidly over the last several years: the federal government’s key ACO initiative, the Medicare Shared Savings Program, now includes more than 360 ACOs serving over 5.3 million Medicare beneficiaries across the country. In addition, commercial payers such as UnitedHealthcare, Aetna, and others, are developing ACOs with providers in their networks.
New approaches to delivering care
Succeeding in new value-based payment models means provider organizations must adopt new approaches to delivering care and engaging patients. For instance, to effectively reduce excessive health care costs, providers must rigorously identify the subset of their patients that are associated with higher costs, such as patients suffering from chronic disease who may be using expensive acute care services due to a lack of effective management in the primary care setting.
In addition, providers must meet new operational requirements that require reporting on quality and financial metrics. Without the right services in place, these requirements can quickly lead to untenable administrative burdens that can be a distraction from improving care, particularly for providers involved in multiple value-based initiatives with different payers.
Health IT tools help to manage data and care
Health information technology solutions that support these capabilities are crucial to successful value-based payment arrangements. For instance, at the individual provider level, electronic health records (EHRs) help providers access patient information and evidence-based guidelines to inform treatment decisions at the point of care. Population health management and registry tools, accessed through EHRs or other channels, help providers understand the overall health of their patient panels and address high priority patients.
To deliver a comprehensive view of the patient and enable robust care coordination, these provider-facing tools must be supported by a broader information infrastructure that ties together collaborating organizations and communities.
In leading edge health care markets across the country, stakeholders including health systems, individual providers, payers, nonprofits focused on quality improvement, and state and local governments, are grappling with how to develop shared assets to support the information needs of providers so they can succeed within the accountable care environment.
A closer look at communities investing in accountable care
A new report prepared for ONC looks at the current national landscape around technology solutions supporting value-based payment models, as well as two case studies of communities that have made significant …read more