Healthcare giants make value-based payment pledge

medical doctor flexing bicepWith and without government, some of healthcare’s largest businesses, and those who pay for it, are mapping their own path to a critical mass of value-based payments.

Aetna, Blue Cross giant Health Care Services Corporation, Ascension Health and Trinity Health are teaming up with employer and patient representatives to affect change through a new industry consortium, the Health Care Transformation Task Force.

The formation of the Task Force comes two days after the Department of Health and Human Services announced a goal for Medicare to shift 50 percent of its provider payments into alternative payment arrangements by 2018.

“We are committed to rapid, measurable change, both for ourselves and our country,” the organizations said. The goal is convene “patients, payers, providers and purchasers to align private and public sector efforts to clear the way for a sweeping transformation of the U.S. health care system.”

Their goal, in fact, is to have 75 percent of the respective businesses operating under value-based payment arrangements by 2020.

Among the Task Force’s provider members are the nation’s largest nonprofit health system, Ascension Health, Trinity, Partners HealthCare in Massachusetts, Advocate Health Care in Chicago, Providence Health & Services on the West Coast, and Dignity Health.

Besides Aetna and HCSC, payers include Blue Shield of California and Blue Cross Blue Shield of Massachusetts. Representing employer purchases are Caesars Entertainment and the Pacific Business Group of Health, and bringing the voice of patients is the National Partnership for Women and Families.

“By joining together with other industry leaders to align the way we provide care and pay for care, this Task Force will achieve the Triple Aim outcomes needed to improve the nation’s health,” said Richard Gilfillan, MD, CEO of Livonia, Michigan-based Trinity Health, who’s serving as the Task Force’s chairman.

The Task Force is going to work in large part on aligning the public and private payer systems and crafting “common accountability targets, metrics and incentives,” as well as best practices.

“Building a healthier world requires fresh thinking and innovation,” said Fran Soistman, executive vice president of government services at Aetna. “By joining together, we are well positioned to introduce more effective change, more quickly, with more impactful results.”

Pacific Business Group on Health CEO David Lansky added that the country cannot keep moving down the fee-for-service path.

“The cost of health care undermines our global economic competitiveness and erodes the financial security of individuals and families,” Lansky said. “We need to align the way we pay for and deliver care with the outcomes we want: better quality and lower costs.”

The Task Force’s work should “send a clear signal that the public and private sector are aligning around a new trajectory for healthcare payments,” the Task Force said.

The consortium has released its first set of ideas for aligning commercial and public ACOs, with the recommendations covering patient choice and attribution, improving quality measurement, and improving financial sustainability.

In terms of aligning and simplying payments, the Task Force has this idea for insurers:

“Payers should offer two statistically sound financial models, designed so that all providers can participate. One should be based on historical claims thereby incentivizing the participation of high-cost providers. The second should be based on community-ratings with health-status adjustments. In developing the latter, local costs/trends should be considered, prospective targets should be set; industry standard risk adjustment models such as the Hierarchical Conditions Categories (HCC) should be utilized and continuously improved. Rebasing methodologies that continuously remove improvements should be eliminated. Financial models should use simple, open-source methods and codes that allow for replicability. Additionally, financial models should, as a rule, carve more care “in” to encourage more comprehensive accountability. For ACOs that do save but are unable to meet the minimum savings rate (MSR), calculations from across the program years should be pooled to recalculate an adjusted MSR.”

The recommendations, “Improving Commercial, Medicaid and Medicare Accountable Care Organizations,” also offer a snap shot of the state of accountable care in the membership of the nation’s largest insurers.

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