It’s hard to disagree with the concept of value-based care. Done correctly, value-based care achieves the “Triple Aim” to improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of healthcare. Simply stated, value-based care means improved care efficiencies and outcomes for your patients.
The current state of value-based care and reimbursement
Unfortunately, transitioning from fee-for-service to value-based reimbursement is far from simple. In a study conducted by ORC International and commissioned by McKesson in 2016, 60-78% of providers said they’re not meeting their alternative payment and value-based reimbursement goals.1 Just 22% of providers reduced administrative care costs, 26% lowered healthcare costs, and 30% hit their care coordination targets.2 Common reasons cited for the shortfalls include struggles with metrics, analytics and data; and personnel, organizational and financial issues.3 The burden of learning and adopting different technology solutions from various payers, and providers’ inherent lack of trust in using payer-provided technology systems could also be contributing factors.
Despite the challenges, payers and providers know the shift to value-based care is inevitable. Pressure is coming from all sides, most notably, last year’s legislative change to the way Medicare pays physicians. In 2015, the U.S. Department of Health and Human Services (HHS) repealed the Sustainable Growth Rate (SGR) and replaced it with the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA, combined with the Patient Protection and Affordable Care Act of 2010, introduced new forms of reimbursement centered on value, and commercial payers are quickly following suit. In fact, payers in the ORC study said 58% of their business has already transitioned to value-based reimbursement, which is a sharp 10% jump from 2014. Providers saw their business evenly split 50/50 between value-based reimbursement and fee-for-service, placing them in the middle of the value-based reimbursement continuum, but still an uptick from 46% in 2014. All reasons indicating why both payers and providers predict payment with measures of value will eclipse fee-for-service by 2020.4
How payers and providers can take a leap forward
While the evolution to value-based reimbursement will ultimately benefit everyone in the care continuum, it raises many questions on how payers and providers can better work together to achieve care efficiencies. To improve outcomes and achieve the Triple Aim, payers and providers need to work strategically and leverage alliances with experts who have a proven track record of successfully implementing business and clinical-support objectives. The right third-party partner will be able to work directly with both payers and providers on providing value-based reimbursement services, including the technology and analytics needed to be successful in implementing value-based programs.
To help solve this dilemma and the need for a strategic partner, McKesson Business Performance Services (McKesson) recently formed a joint venture with Blue Cross Blue Shield of Arizona (BCBSAZ) to deliver services to help healthcare providers succeed in the value-based environment. Our payer-neutral company, called ACO Partner, leverages McKesson’s physician engagement, care management, and population health services and technology to help providers with the practical components of value-based care. The first payer to contract with ACO Partner is BCBSAZ, with other payers currently reviewing the program.
How ACO Partner helps payers and providers on the value-based care continuum
Here’s how the payer-provider collaboration works: On the care quality side, ACO Partner contracts with payers and works with their network providers to improve the patient experience, population health, and care efficiencies. ACO Partner gives providers access to a full spectrum of value-based services—all without the provider having to take on additional costs or responsibilities. These services include:
- Practice education
- Clinician collaboration
- Care coordination
- Payer collaboration for complex case management
- Health and wellness programs
ACO Partner also helps providers distill key information, create reports, develop metrics and implement best practices while clinicians focus on the delivery of care. Our expert staff utilizes data from both participating payers and providers to measure improvements, identify areas for improvement, and create non-disruptive workflow solutions to achieve the desired results.
On the care efficiency side, payers who contract with ACO Partner offer financial incentives to participating network providers. ACO Partner assist in the creation and modeling of the financial contract and required reporting to ensure all parties involved are able to succeed. For the first payer partnership with BCBSAZ, participating providers will have the ability to earn incentives through a shared savings contract. Network providers who participate will open a new revenue stream for increasing and sustaining high levels of quality care by meeting and exceeding predefined benchmarks; all while remaining independent and continuing with their current rates, standards and reimbursement methods. There is no cost or risk for providers who join, and providers are free to work with or be a member of any other organization.
The ACO Partner advantage
ACO Partner is payer-neutral and plans to contract with payers nationwide, with an initial focus on payers who have defined market shares in the state of Arizona. By partnering with ACO Partner, payers and providers both benefit by improved outcomes and care efficiencies through:
- Increased primary care physician visits
- Increased collaboration throughout continuum of care
- Increased patient engagement and disease management
- Increased use of social services contributing to the health of patients
- Fewer avoidable admissions, emergency room visits, and readmissions
- Increased use of high-quality referrals
- Increased use of generic pharmaceuticals
The ACO Partner value-based services organization model helps payers and providers move more quickly along the value-based continuum of change. Through value-based services and a reliable technology infrastructure, our organization helps healthcare providers deliver the best care with improved efficiencies. In turn, patients receive higher quality of care at a better value.
McKesson’s Value-based Care Services can help your organization transform care delivery, develop and engage physician networks and manage risk.
Find out more about how ACO Partner helps payers and providers find success on the path to value-based care and reimbursement.