The Health Care Task Force, which is comprised of Aetna, Health Care Services Corporation, Blue Shield of California and BCBS of Massachusetts and several providers, has a difficult goal to acheive: Establishing a standard for value-based care.
By aligning both payers and providers, the alliance believes the industry can transition to paying for value, rather than volume, by achieving the Triple Aim--improved care, improved outcomes and reduce costs, as FierceHealthcare previously reported.
So, in order to achieve their end-result, the task force will focus on aligning both public and private accountable care organizations (ACOs), reported Healthcare Payer News. Listed below are two areas that payers and providers can work on to reach the goal of value-based care, according to the article.
The task force recommends payers create an environment that focuses on using quality measurement for ensuring appropriate payments and consumer engagement. More importantly, it says both private and public payers need to establish a uniform way of paying for performance.
Payers and providers need to figure out a way to reward for both improvement and achievement. In order to do so, the task force announced it recommends "incentivizing improvement over prior performance in addition to achievement relative to industry standards." Ultimately, there needs to be an "aligned approach" when it comes to payment methods.
Lastly, the task forces calls on ACOs to create incentives that encourage quality measures. From a payer standpoint, it's important to think differently, FierceHealthPayer previously reported. Insurer-led ACOs should launch new reimbursement methods with early adopters, or doctors, who are willing to try new things and see value in innovations.
When it comes to establishing financial stability, the task forces recommends that payers focus on new payment models that ensure provider participation.
While one model uses the participation of high-cost providers, the other should feature community-ratings with health-status adjustments, according to HCPN. These two models should have "simple, open-source methods and codes that allow for replicability," notes the task force.
Because ACOs are costly to establish, payers and providers need to work together to lower the costs and administrative burden. The task force said it believes that ACOs should move quickly to a two-sided risk model.
- here's the HCPN article