The accountable care industry is changing. There is a fundamental shift in risk-based contract management, with value-based reimbursement leading the charge. Traditional fee-for-service models are fading away, driving many physicians to seek out organizations that can help them survive financially while remaining clinically autonomous.

These were the takeaways from the recent presentation given by McKesson at HFMA’s 2015 National Institute. What does this shifting landscape mean for today's healthcare financial leaders?

Based on the HFMA session presentation from John Wallace of McKesson and Dr. Jerry Floro of Pioneer Medical Group, here are the reasons why the landscape is changing for accountable care.

  1. Payment models are shifting.
  2. Wallace and Floro noted a clear shift in payment models for risk-based contracts, citing a 2012 study from Leavitt Partners. The study predicted a transformation for payment arrangements, with a 50% increase in physicians accepting non fee-for-service contracts over the next seven years.

    The ultimate goal of this transformation, according to the presenters, lies in population-based alignment of reimbursement incentives. Along with clinical outcomes to control costs and enhance patient care, the new payment models will drive more physicians to embrace organizations that pledge both financial stability and clinical autonomy.

  3. Delivery models are shifting.
  4. New payment models are subsequently affecting delivery models, pushing the overall industry from payments-per-unit to performance-based. Wallace and Floro noted that the following trends are being developed as performance-based models are implemented:

    • Payment and administrative complexity grows, as risk is shared. The trend moves from payments-per-unit to payment for overall outcomes.
    • Measurement changes as accountability and data are shared. The trend moves from throughput to outcomes.
    • Delivery models must place greater emphasis on performance and care outcomes. The trend moves from encounter-based to patient-based deliveries.

  5. The Medicare Advantage Model is shifting.
    With the shifting models outlined above, it’s even more important to stay on top of the documentation. Wallace and Floro also noted that there is a wide gap between organizations on the Medicare Advantage Model and those that are not, especially when it comes to managing care and cost outcomes.

These three areas showcase the wide shift that the accountable care industry has experienced in the past several years. Before this shift, the majority of information was slanted to the independent physician market space. However, the market is now telling us something different, and physicians need to be ready to make quick adjustments.

Get Actionable Insights on Accountable Care Management We’ll cover how to achieve success with risk-based contracts in our next post 4 Keys of Success with Managing Risk-Based Contracts. For more information about accountable care management, download a special value-based care report from McKesson on an 11-Year risk-sharing arrangement under Medicare Advantage.

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About the author

John Wallace has extensive experience developing and implementing value-based payment models, working with physicians, hospitals and payers nationwide to deliver cost effective, high quality care for patients. A member of McKesson’s executive leadership team, he has responsibility for development of accountable care models, programming and delivery. His ACO expertise includes strategic planning, business development, joint ventures, group practice leadership, risk model development and operational integration.