Accountable care needs to help patients as well as cut costs

Doctors talking
Alternative payment models must encourage teamwork and help make patients better healthcare consumers, according to two viewpoint articles in JAMA. (Getty/wmiami)

Value-based care is an essential approach for hospitals to become more cost efficient, but the model must also relieve the burdens on patients by providing them with better care.

That’s the conclusion of two separate articles examining value-based care recently published in the Journal of the American Medical Association.

The first viewpoint article, co-authored by former CMS Administrator Mark McClellan, M.D., Sam Nussbaum, M.D., and healthcare economist Grischa Metlay, Ph.D., laid out a framework for alternative payment models. It noted that such models “must help make patients better healthcare consumers and mitigate perverse incentives that reward low-quality patient care.”

The authors also called for the need of additional safeguards to protect patients from "incentives to withhold clinically proven services that require healthcare professionals to assume financial risk.” Overall, they wrote, payment reform “is not an end; it is a means to supporting better, more coordinated care for patients.”

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The second viewpoint article, co-authored by Harvard Medical School faculty members Ishani Ganguli, M.D., and Timothy G. Ferris, M.D., observed that the accountable care organization model may be the way to correct some of the flaws in care delivery created by the still dominant fee-for-service model. But they also insisted on more teamwork within that model.

“Systems must engage specialists, for instance, by asking them to work with primary care physicians to develop co-management strategies for mutual patients with complex conditions or by incentivizing alternatives to in-person visits,” they wrote.

Related: CMS: More than 120 new participants join the Medicare Shared Savings Program for 2018

But it remains to be seen as to whether the federal government will fully support alternative payment models. The Trump administration has pushed to eliminate quality reporting for physician practices as part of its 2019 proposed budget. The reporting under the Merit-Based Incentive Payment System, or MIPS, as part of the Medicare Access and Chip Reauthorization Act (MACRA) would be scrapped, although the White House budget is often just a guideline and may not be adopted by Congress in its final budget. 

The Centers for Medicare & Medicaid Services also decided late last year to eliminate a potential ACO testing bed by ending the Shared Decision-Making Model due to what the agency claimed was a lack of volunteer participants among ACOs. Such a model would have given patients more of a voice in their care for health issues where there is still no clear-cut treatment protocol, such as for hip or knee osteoarthritis, or clinically localized prostate cancer.

CMS did not disclose how many ACOs were willing to participate in the Shared Decision-Making Model, which was first proposed by the Obama administration.