$840M Plan Unveiled to Boost Transitions to Outcome-Based Healthcare

If healthcare providers need another reason to move from fee-for-service delivery models to those based on patients’ health outcomes, the US Department of Health and Human Services (HHS) just provided one: an $840 million initiative, most of it grants, to help fund the cost of making the transition.

HHS Secretary Sylvia M. Burwell yesterday unveiled a program that will allow successful applicants to receive federal dollars to help them “rethink and redesign their practices,” while moving toward delivery models based on coordinated care and improving population health, according to a department statement.

The plan seems tailor-made to boost efforts by accountable care organizations (ACOs), which were created by the 2010 Patient Protection and Affordable Care Act (ACA) to allow entities of hospitals, practice groups, health plans, and other medical providers work together to improve health and patient satisfaction — and find savings – across a population. ACOs that make the grade, based on quality measures from the Centers for Medicare and Medicaid (CMS), are eligible for higher reimbursements from Medicare.

Giving ACOs the opportunity to learn from each other as they make this transition is a chief initiative of The American Journal of Managed Care, which recently brought a multistakeholder group of healthcare leaders together for its ACO and Emerging Healthcare Delivery Coalition meeting in Miami.

The HHS announcement said the program hopes to reach 150,000 healthcare providers through the Transforming Clinical Practice Initiative, which will take aim at things like unnecessary tests and repeated hospitalizations.

To date, CMS has encouraged a transition from volume- to value-based care through 2 programs: the Pioneer ACOs, large systems that already had some experience with value-based delivery, and the Medicare Shared Savings Program, which has enrolled hundreds of ACOs of varying size and composition. So far, however, the Pioneers program has had mixed success; a paper just published this week by the Journal of the American Medical Association outlined the challenges of the early years of the program, which launched in 2011. Since 2012, the Pioneers program has shrunk from 32 to 19 participants.

According to the HHS announcement, strategies that the new program hopes to promote include:

• Giving doctors better access to patient information, including information on prescription drug use to help patients stick with medication schedules;
• Expanding the ways patients can communicate with the team of clinicians taking care of them;
• Improving the coordination of patient care by primary care providers, specialists, and the broader medical community; and
• Using electronic health records on a daily basis to examine data on quality and efficiency.

“The administration is partnering with clinicians to find better ways to deliver care, pay providers and distribute information to improve the quality of care we receive and spend our nation’s dollars more wisely,” Burwell said. “We all have a stake in achieving these goals and delivering for patients, providers and taxpayers alike.”

Another part of the initiative will be Support and Alignment Networks. CMS will award “cooperative agreements” to professional associations that educate members in value-based practices, through continuing medical education credits and other means.

Around the Web

Transforming Clinical Practice Initiative

Grant Opportunities from HHS

Data Collection, Telehealth, and Importance of Primary Care Physicians Get Attention at ACO Coalition Meeting

JAMA Article Outlines the Growing Pains of Pioneer ACOs