Vital Directions for Health & Health Care An Initiative of the National Academy of Medicine (2017) / Chapter Skim
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10. Competencies and Tools to Shift Payments from Volume to Value
10. Competencies and Tools to Shift Payments from Volume to Value
Pages 221-232
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From page 221... ...
The Health Care Payment Learning and Action Network has described a variety of payment reforms (Health Care Payment Learning and Action Network, 2016) and accompanying delivery models that represent a shift away from FFS, such as accountable care organizations (ACOs)
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From page 222... ...
Pressure is rising to delay MACRA and other payment reforms, especially for smaller health care organizations and those serving vulnerable populations, because providers are not ready. From the standpoint of achieving the goals of higher-value care, policies to support care-delivery transformation are as critical as effective payment reforms.
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From page 223... ...
TABLE 10–1 | E xamples of Learning Collaboratives COLLABORATIVE DESCRIPTION Learning and Action Department of Health and Human Services–supported program to sup Network (LAN) port adoption of alternative payment models, with a focus on sharing information and evidence related to new payment models Health Care Industry consortium aligning public and private sector toward care Transformation Task transformation with widespread adoption of new payment models and Force (HCTTF)
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From page 224... ...
The collective goal for many groups is to help health care providers to develop needed competencies for care-delivery reform and to support providers in succeeding in value-based payment models. Many organizations are undertaking similar efforts on their own, but the unique benefit of collaboratives is the aggregation of both public and private evidence and expert opinion on how to improve care.
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From page 225... ...
Competencies and Tools to Shift Payments from Volume to Value | 225 TABLE 10–2 | ACLC Competency Domains and Scope of Competency DOMAIN SCOPE OF COMPETENCY Governance and culture Leadership and policy development; provider accountability; board representation for clinicians, community, and patients; decision-making processes aligned with value-based objectives Financial readiness Ability to assess longitudinal patient resource use; evidence-based mech anisms for management of financial and performance risk; established provider networks; mechanisms to distribute shared savings payments Health information Capacity to assess and implement products, platforms, and processes technology for accessing and using health care data; reliable and timely acquisition of key actionable data for longitudinal patient management; analytics to predict intervention impact Patient risk assessment Ability to assess patient needs for chronic-condition management and navigating the health system and to target strategies and specific resources to patients by using a validated risk- and impact-assessment tool Care coordination Longitudinal-care team with well-defined roles and responsibilities that foster continuity of care; mechanisms for access to well-targeted and community-based social services; reliable, straightforward sharing of encounters, test results, and other key information across care team Quality Capacity to assess and implement high-impact interventions to make care safer, more effective, patient-centered, timely, efficient, and equitable; provider and staff training; quality-improvement initiatives that are evidence-driven with impact measurement and adjustment Patient-centeredness Capacity to help people to maintain or return to health, supported by patient-driven, health-measurement capacity; incorporation of patient perspective into governance, care-system design, and individual interaction; capturing the individual patient's values, preferences, and expressed needs in care plans Health IT Utilize data from Patient- Care mobile devices for risk Centeredness Coordination assessment Platform for Patient Assessment Identify diagnoses that drive spending for risk Risk assessment Assessment Data Governance Patient Risk & Culture Assessment Keep risk assessment Implement- data sources and infor ation & Data mation updated Processing Financial Develop a process to Quality Reporting use clinical notes for Readiness risk assessment FIGURE 10–2 | C ompetency domains and their complete set of capabilities.
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Iden fy Plan for High Pre-launch Opera onal Competencies Improvement Performing Competency stages of development FIGURE 10–3 | C ompetency provider journey map. Accelerating the Development of Health Care Capabilities to Succeed in Value-Based Payment Models Even with resources like those being developed in the ACLC and other collaboratives, delivery reform is challenging.
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From page 227... ...
Secretary Sylvia Burwell's 2015 announcement to shift 80 percent of care into value-based purchasing models by 2018 and related initiatives, such as the Health Care Payment Learning and Action Network. However, despite the need for payment reform, without organizations that are able to function well with new payment models, progress both in payment and in delivery of higher-value health care will be slow and cumbersome.
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From page 228... ...
For example, CMS "learning networks" for particular Medicare payment reforms should be conducted in closer collaboration with private-sector efforts in similar payment reforms with specific goals for improved resources for providers. High priority should be attached to better tools for different types of providers to assess gaps and to track and evaluate progress in APM capabilities through the development, refinement, and wider use of measures of key care-delivery competencies.
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From page 229... ...
Government can mitigate failures and increase successes by advocating for and participating in industry collaborations and by adopting the resulting knowledge in regard to value-based care competency measurement and benchmarking, shared competency evidence development, value-based health care education reform, and increasing access to data available through HIT. The collective state of and spending on American health care has created a small window for the private and public sectors to coalesce around the adoption of value-based care.
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3. Align federal payments for health professional education with value based health care competencies.
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From page 231... ...
2016. Leading health care transformer joining Dell Med.
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