Private-sector alliance to transform healthcare payment models
WASHINGTON — Only days after the Department of Health and Human Services set a goal of tying 30% of traditional, fee-for-service, Medicare payments to quality- or value-driven alternative payment models, several of the nation’s largest healthcare systems and payers, joined by purchaser and patient stakeholders, on Tuesday announced a powerful new private-sector alliance dedicated to accelerating the transformation of the U.S. healthcare system to value-based business and clinical models aligned with improving outcomes and lowering costs.
Together, the two announcements send a clear signal that the public and private sector are aligning around a new trajectory for healthcare payments that moves away from fee-for-service and into alternative payment models.
The Health Care Transformation Task Force, whose members include six of the nation’s top 15 health systems and four of the top 25 health insurers, challenged other providers and payers to join its commitment to put 75% of their business into value-based arrangements that focus on the Triple Aim of better health, better care and lower costs by 2020.
“The formation of this Task Force and its ambitious goal demonstrate that the private sector embraces a value-based approach to improving care and lowering costs,” stated Richard Gilfillan, CEO of Trinity Health and the Task Force’s chairman. “We are committed to rapid, measurable change both for ourselves and our country that will improve quality and make health care more accessible for all American families.”
Attempting to change the healthcare payment structure was last attempted in the 1990s with the creation of health maintentance organizations, noted The New York Times in its coverage of the coalition formation. "But those efforts largely failed because of an overemphasis on cost and rules that were seen by doctors and patients as too restrictive," The New York Times reported. "Several coalition members said, however, that they had learned from those earlier mistakes."
Participants in the Health Care Transformation Task Force provide a critical mass of business, operational and policy expertise to increase the momentum of delivery and payment system reforms. The task force’s diverse membership of providers, payers, purchasers and patients, as well as academic and policy leaders, uniquely positions it to offer recommendations to both policymakers and the private sector that reflect consensus and can thus gain wide acceptance and use.
The task force will seek to align private and public sector changes in the way providers are paid. “Building a healthier world requires fresh thinking and innovation. It calls for everyone in health care to rally around the single goal of improving health and service while reducing costs — whether you give care, receive care, manage care or pay for care," commented Fran Soistman, EVP government services at Aetna. "This Task Force brings together a cross section of leaders, working together to find better ways to improve the health of people and communities. By joining together, we are well positioned to introduce more effective change, more quickly, with more impactful results.”
The Task Force will develop timely and actionable policy and program design recommendations for the private sector. The Centers for Medicare & Medicaid Services, Congress and others; new delivery and payment models; and the best-practice tools, benchmarks and approaches will implement them. Initial priorities include improving the Accountable Care Organization model, developing common bundled payment framework and improving care for high-cost patients.
Today, the task force also released its first consensus recommendations on how best to design the next generation of the ACO model in commercial, Medicare and Medicaid programs. The recommendations will form the basis of the task force’s upcoming comment letter on the CMS proposed changes to the Medicare Shared Savings ACO program.
The task force defines value-based payment arrangements as those which successfully incentivize and hold providers accountable for the total cost, patient experience and quality of care for a population of patients, either across an entire population over the course of a year or during a defined episode that spans multiple sites of care.
While the providers and payers are committing to new business and clinical models, the purchaser and patient members are committing to creating and sustaining the demand, support and education of their constituencies necessary to reach the goal. “Our goal is clear — to reform our health care system so that it finally delivers the high-quality, coordinated, patient- and family-centered care that families deserve,” said Debra Ness, president of the National Partnership for Women & Families.
David Lansky, president & CEO of Pacific Business Group on Health, echoed this sentiment: “We need to align the way we pay for and deliver care with the outcomes we want: better quality and lower costs. The country cannot continue down the path of fee-for-service medicine that produces fragmented and unsafe care. The cost of health care undermines our global economic competitiveness and erodes the financial security of individuals and families. Our goal is transformation that achieves value and improved health outcomes.”