Some of the largest payers, providers, consumers, and purchasers of health care in the United States announced January 28, 2015, that they have banded together to speed health care transformation. The new Healthcare Transformation Task Force (HTTF) vows that payer and provider members will operate 75 percent of their businesses under value-based payment arrangements by 2020.
Since many of the task force members are among the largest providers of and payers for care, the impact of reaching this goal will be noticeable. Among the 16 participants so far are the two largest nonprofit hospital systems in the United States (Ascension and Trinity Health), and three that are among the 15 largest systems. As for the four payers signed on, three are in the top 10 in terms of market share (Aetna, Blue Shield of California, and Health Care Services Corp [HCSC]). Pacific Business Group on Health and Caesar’s Entertainment represent the HTTF purchasers, and the National Partnership for Women & Families will act as the voice for patients and families. Among the partners and policy experts are a high-level executive with the Brookings Institution and a former policy advisor for the White House.
The recent passage of the Medicare Access and CHIP Reauthorization Act on April 14, 2015, will only speed the transition to value-based payment. The legislation does not just eliminate future cuts to the sustainable growth rate—it also provides incentives for providers to participate in alternative care organizations(ACO) and better coordinates existing Medicare quality reporting programs.
The HTTF dubs its goal the triple aim of “better health, better care, and lower costs,” echoing closely what Department of Health and Human Services Secretary Sylvia Mathews Burwell calls her agency’s “better care, smarter spending, healthier people” initiative.
Under the HHS program, announced two days before HTTF was made public, half of Medicare payment would be based on quality of care rather than quantity of services through alternative payment models by 2018.
The task force plans to recommend timely and actionable policies and program designs for the private sector, the Centers for Medicare and Medicaid Services (CMS), Congress, and others; new delivery models; and the best-practice tools, benchmarks, and approaches to implement them through its targeted workgroups. Such an approach not only could lead to providing better care more efficiently, but gives industry players a louder voice in influencing the direction of changes to payment systems. In 2015, the task force will study and develop policy recommendations for accountable care organizations (ACO), high-cost patients, and bundled payments.
It is important for providers to make sure they speak out about reimbursement approaches so they can influence the end results. They also must constantly be on the lookout for payment changes to head off serious financial consequences. For instance, diagnosis coding will take on even more importance with capitated payment models (such as accountable care organizations) that set per member per month rates based on diagnoses. Not being aware of the full effects of accurate coding could lock in a practice at an unfavorable rate.
Of course, the success of any value- and outcomes-based payment system rests on patient compliance with treatment. In a perfect world, all patients would have the resources and motivation to follow through with treatment plans. However, studies have shown that, even in clinical trials, which typically enjoy a higher rate of adherence than nonclinical trials, 22 percent to 57 percent of participants with chronic conditions do not comply with treatment (New England Journal of Medicine, 2005; 353:487-497). Various past attempts to improve patient compliance have had limited success, with the most successful efforts being complex and expensive.