3 key considerations for ACO model agreements

Patient experience and access, financial structures and quality of care are must-have elements for all accountable care organization (ACO) contracts, according to a new memo issued by the Health Care Transformation Task Force, an industry consortium made up of patients, payers, providers and purchasers.

The task force aims to help transform the U.S. healthcare system and speed the industry adoption of value-based systems. The new action memo is meant to help all organizations that are just moving into the accountable care space, Emily Brower, pictured, vice president of population health for Atrius Health and a task force member, said in an exclusive interview with FierceHealthcare.

The contract elements are discussion points for all types of models, such as Medicare ACO models, commercial payer ACOs, physician-led ACOs, or models developed in partnership with providers, employers or payers, according to Brower. She offered the provider perspective based on her experiences working for the Northeast's largest nonprofit independent multi-specialty medical group and an original Pioneer ACO.

"Hopefully this contributes to the marketplace of ideas," said Brower, "as it comes from multiple perspectives and offers a document that you could go to regardless of which participant you are in the marketplace."

The nine-page document calls for all ACO contracts to consider:

Patient experience and access--The memo offers practical contracting strategies to promote patient-centered care, such as a focus on the primary care relationship, coordination and communication, access to timely care and best practices for care management, particularly for high-cost, high needs patients. To establish a successful ACO, the task force emphasizes the selection of a designated population that has a sufficient number of patients and calls for a robust information exchange that drives transparency and accountability.

Financial structure–Contracts must have a financial model that will support the Triple Aim of an improved patient experience, high quality of care and lower costs.The task force recommends leaders include one or two statistically sound, fully transparent financial models that allow all providers to participate. One model should be based on historical claims experience, the other on community ratings with local costs/trends. Effective contracts, according to the memo, clearly define the financial responsibility between the purchaser, payer, provider and/or patient. It also outlines well-defined benchmarks or global budget and performance period. However, because circumstances may change over time, the task force recommends that the contracts allow for ongoing access to data and periodic reviews to make necessary adjustments.

Quality of care--The contracts also must clearly define the design of the clinical model. Leaders must determine whether the ACO will be solely responsible for clinical management or whether it will share responsibilities with the health plan/payer, including  any needed delegation of care, case and disease management authorities. The task force also includes information on setting and monitoring key quality measures to ensure patients always have access to necessary care.

Brower said that many of the contract elements that she values as a provider were the same as those suggested by payers, purchasers and patients on the task force. Patients, she said, also want transparency in models, they want to understand what it means to be a member of an ACO and they want to be engaged in the process.

"Folks who were speaking from the patient perspective also said the idea of engagement was important to them, which are words that typically come from the payer, provider or employers," said Brower. "Those same goals may have been said a little differently but they are there in the patient community.They want to understand these models and they want to be active in creating these new models."

To learn more:
- here's the memo (.pdf)
- read the announcement
- check out the task force website