Insurers, Hospitals Form Payment Reform Alliance

AN INITIAL FOCUS OF THE HEALTH CARE TRANSFORMATION TASK FORCE IS AN OVERHAUL OF ACCOUNTABLE CARE ORGANIZATIONS, WHICH HAVE DRAWN INCREASING PROVIDER INTEREST AND CRITICISM.
AN INITIAL FOCUS OF THE HEALTH CARE TRANSFORMATION TASK FORCE IS AN OVERHAUL OF ACCOUNTABLE CARE ORGANIZATIONS, WHICH HAVE DRAWN INCREASING PROVIDER INTEREST AND CRITICISM.<br />Jan. 30—As Medicare ramps up the transition to value-based payment, a new alliance of providers and payers has suggested changes that might help.The Health Care Transformation ...

Jan. 30—As Medicare ramps up the transition to value-based payment, a new alliance of providers and payers has suggested changes that might help.

The Health Care Transformation Task Force, an alliance of six large health systems and four large health insurers, launched this week with a goal of pushing 75 percent of the members’ business into value-based arrangements 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,” Richard J. Gilfillan, MD, CEO of Trinity Health and chairman of the task force, said in a release. Gilfillan was the director of the Centers for Medicare & Medicaid Services’ (CMS’s) Innovation Center for the Obama administration until 2013.

The task force’s formation came two days after CMS officials announced a goal to shift 50 percent of Medicare provider payments into alternative payment arrangements, such as accountable care organizations (ACOs) or bundled payments, by the end of 2018.

“Misaligned incentives and a lack of coordination among stakeholders have been a major impediment to the transition to a more value-focused healthcare system, and it is promising to see a diverse coalition of stakeholders building consensus and moving toward a common goal,” said Jim Landman, director of healthcare finance policy, perspectives and analysis, for HFMA.

ACO Focus

The task force immediately offered recommendations to both policymakers and the private sector on consensus changes that can gain widespread acceptance and use. Its initial recommendations focused on changes to the accountable care organization (ACO) model in commercial, Medicare, and Medicaid programs.

For the Medicare Shared Savings Program (MSSP)—Medicare’s primary ACO program—to play a significant part in growing the share of payments that are tied to quality, the U.S. Department of Health and Human Services (HHS) would likely have to make significant changes to it, according to some providers. HHS proposed an overhaul of the MSSP program in December that would include reducing the financial barriers to providers’ participation in the program.

The task force plans to spell out specific recommendations for ACO changes in a comment letter to CMS, as part of the agency’s MSSP overhaul.

Critics of Medicare ACOs have charged that they offer little incentive for providers to undertake the major expenditures needed to implement them. Critics also say there is little quality improvement incentive following CMS’s waiving of certain quality improvement benchmark standards to allow for continued participation only in upside risk sharing.

“The task force’s ability to closely monitor the success of new models in promoting value-based care and to rapidly respond in cases where evidence suggests that a particular model is not achieving this goal will be critical to this effort,” Landman said. “So too will be the coordination of efforts by CMS and the task force to ensure consistency of direction for healthcare systems as they dedicate their resources to the transition to value.”

The new alliance’s other initial priorities include developing a common bundled payment framework and improving care for high-cost patients.

Source: www.hfma.org