A growing number of care providers across the country are participating in value-based payment arrangements that are helping to transition the nation away from traditional fee-for-service methods of paying for health care. While fee-for-service models offer little accountability for health outcomes, more and more providers are using new models that reward their ability to deliver higher quality care with greater efficiency.

Accountable Care Organizations (ACOs) are a prominent example of value-based payment. Under these programs, groups of providers agree to assume responsibility for the total cost of care of a patient population while maintaining or improving quality, in exchange for the chance to share in any savings generated due to better care.

ACOs have spread rapidly over the last several years: the federal government’s key ACO initiative, the Medicare Shared Savings Program, now includes more than 360 ACOs serving over 5.3 million Medicare beneficiaries across the country. In addition, commercial payers such as UnitedHealthcare, Aetna, and others, are developing ACOs with providers in their networks.

New approaches to delivering care

Succeeding in new value-based payment models means provider organizations must adopt new approaches to delivering care and engaging patients. For instance, to effectively reduce excessive health care costs, providers must rigorously identify the subset of their patients that are associated with higher costs, such as patients suffering from chronic disease who may be using expensive acute care services due to a lack of effective management in the primary care setting.

In addition, providers must meet new operational requirements that require reporting on quality and financial metrics. Without the right services in place, these requirements can quickly lead to untenable administrative burdens that can be a distraction from improving care, particularly for providers involved in multiple value-based initiatives with different payers.

Health IT tools help to manage data and care

Health information technology solutions that support these capabilities are crucial to successful value-based payment arrangements. For instance, at the individual provider level, electronic health records (EHRs) help providers access patient information and evidence-based guidelines to inform treatment decisions at the point of care. Population health management and registry tools, accessed through EHRs or other channels, help providers understand the overall health of their patient panels and address high priority patients.

To deliver a comprehensive view of the patient and enable robust care coordination, these provider-facing tools must be supported by a broader information infrastructure that ties together collaborating organizations and communities.

In leading edge health care markets across the country, stakeholders including health systems, individual providers, payers, nonprofits focused on quality improvement, and state and local governments, are grappling with how to develop shared assets to support the information needs of providers so they can succeed within the accountable care environment.

A closer look at communities investing in accountable care 

A new report prepared for ONC looks at the current national landscape around technology solutions supporting value-based payment models, as well as two case studies of communities that have made significant investments to support their transition away from the fee-for-service system:

• Bangor, Maine, one of the 17 Beacon Communities funded by ONC under the American Recovery and Reinvestment Act program, now hosts a number of value-based payment initiatives. These include federal ACO programs under Medicare and state initiatives leveraging the Maine Medicaid program to support advanced care delivery models in primary care. ACOs are implementing systems to improve care coordination across participating providers, while leveraging a variety of statewide resources to facilitate data aggregation and streamlined reporting, such as HealthInfoNet, the state’s health information exchange, and a robust network of organizations focused on quality reporting and metrics.
• Many of the key health care organizations in Austin, Texas, have begun focusing on value-based initiatives over the last several years. Stakeholders have participated in the federal Medicare Shared Savings Program and Pioneer ACO programs, state efforts using Medicaid funding to incentivize quality improvement, as well as a wide ranging commercial health plan program around patient centered medical home models. In addition to organizations investing heavily in the use of EHRs, stakeholders are leveraging ICare, a regional health information exchange, particularly those focused on new delivery models serving Medicaid and uninsured populations.

In addition, these case studies highlight many of the challenges that stakeholders are facing on the ground in their efforts to develop new models of care. Challenges include evolving standards around interoperability; competitive pressures that reinforce fragmentation in the health care system and inhibit collaboration around shared assets; and limited access to claims and clinical data across settings and sources. These case studies will help to illuminate important examples of how stakeholders are coming together to ensure providers have access to the information, tools, and services they need to succeed in the accountable care environment. While there is widespread consensus that IT solutions are critical to enabling many of the capabilities needed for accountable care, providers, patients, payers, government entities, and others will need to work closely together to realize the vision of a truly patient-centered, value-oriented health care delivery system.