Principles to Support Accelerated Value-Based Payments
A new industry coalition, the Health Care Transformation Task Force, starts with 28 providers, payers, patient advocates and policy experts, and a goal of putting 75% of their businesses in value-based payment arrangements by 2020. The group seeks more participants and has issued an initial list of consensus principles on designing the next generation of ACO models for commercial and government insurance programs. These principles will form the basis of a letter to CMS for changes to the Medicare Shared Savings ACO program.
Honoring Patient Choice and Improving Attribution
Efforts to meet the Triple Aim (better health, better care & lower costs) are enhanced when an ACO works with an identifiable patient population. Attribution models should support a patient’s ability to actively attest to their participation in a particular ACO. Beneficiaries would receive tentative assignment based on historical claims data and would then have the opportunity to confirm attribution through a variety of methods, including through official communications with the payer and in response to direct ACO outreach. A new report from the task force walks through the principles.
Quality Measurement Improvement
Principle 1: As ACOs pursue the Triple Aim, payers should create an environment where quality outcomes measurements can be used for more appropriate payment, consumer engagement and public accountability. Principle 2: Establish an aligned approach to quality measurement across all three domains. Using nationally endorsed measures, where possible, will lead to uniformity that providers need.

Principle 3: Explore two statistically-sound quality measurement approaches, establishing a system that rewards both improvement and achievement. Principle 4: Incentivize ACOs to contribute to emerging/innovative measures and diffuse best practices for quality improvement.
Improving Financial Stability, Part 1
Principle 1: Simplify the Financial Model. Payers should offer two statistically sound financial models, designed so that all providers can participate. One should be based on historical claims to incentivize participation of high-cost providers. The second should be based on community ratings with health status adjustments. Principal 2: As ACOs accept more financial risk and demonstrate high quality care, allow them to better facilitate prospectively-attributed beneficiary receipt of care in appropriate settings. Payment policies that determine the site of care for beneficiaries rather than physician judgment should be waived. Payment changes to complement the move to full risk, such as bundled payment, prepayment and capitation, should be pursued.
Improving Financial Stability, Part II
Principle 3: There is a need to improve reliability and comparability of existing data sets. For delivery systems, a robust process for changing or updating data sets such as test files should be developed. Regulatory changes to remove suppression of mental health and substance abuse-related claims should be supported. Principle 4: Support transition to Triple Aim programs. The impact of requirements that lead to significant startup costs and administrative burden for those making the transition should be lessened, especially for smaller systems and physician groups.
Information on the Health Care Transformation Task Force, including a list of its charter members is here.

More details on the principles are available here.