Health insurers, physicians and accountable care organizations issued recommendations Wednesday outlining what they see as the best ways to boost value-based care initiatives.
The report from the health insurance trade group AHIP, the American Medical Association and the National Association of ACOs focuses on total-cost-of-care contracts, ACOs that typically span three to five years and have demonstrated success improving quality and reducing costs, according to the organizations.
Related: Health insurers retreat from ACO REACH
The Centers for Medicare and Medicaid Services has an ambitious plan to enroll all fee-for-service Medicare enrollees in an ACO or similar arrangements by 2030. Value-based care has gained a smaller foothold in the employer-sponsored insurance, exchange and Medicaid markets.
To broaden adoption of ACOs in the marketplace, AHIP, the AMA and NAACOS maintain that insurers and providers need to properly attribute patients to the correct providers, predict costs, account for quality investments and determine whether or to what extent participants should carry risk. Regional differences in population health and social and economic factors can also complicate payment models, the report said. AHIP, the AMA and NAACOS issued joint recommendations on data-sharing last year.
Here are five highlights from the AHIP-AMA-NAACOS report on value-based payment:
- ACOs should review claims and assign patients to clinician panels to ensure they are linked to the primary care providers who manage their care.
- Insurers and providers should use historical data to predict costs, guard against unexpected expenses and avoid frequently redefining financial benchmarks when structuring value-based contracts. The Medicare Shared Savings Program's stop-loss program offers a blueprint for how to insulate providers from surprise costs.
- ACOs should fund quality improvement and bonuses, regardless whether payers and providers reduce costs. The Medicare Advantage Star Ratings program provides a framework for what quality measures to prioritize and for how to account for differences in population health.
- Insurers should provide transparent, timely data on providers’ anticipated savings and quality awards and should establish appeals processes for providers. Insurance companies should extend prospective payments to providers new to value-based care or that have fewer resources and should offer provisional settlements to providers, like under ACO REACH.
- Insurers should standardize bonus payment timelines, data-sharing tools and quality metrics for providers across Medicare, Medicaid and commercial plans.
