Major Stakeholder Groups Convene on Value-Based Best Practices

Execs from the plan, physician and ACO space roll out playbook, with initial focus on data.

AHIP has collaborated with the American Medical Association (AMA) and the National Association of ACOs (NAACOS) on a joint playbook: The Future of Sustainable Value-Based Care and Payment: Voluntary Best Practices to Advance Data Sharing.

As noted in the AHIP press release, the playbook seeks to grow private-sector VBC arrangements that increase quality, equity, and participation; are sustainable for all stakeholders; and use valuable, real-world insights to design, implement, and evaluate these arrangements.

The release notes that the playbook "marks the beginning of an ongoing partnership between three prominent industry leaders, united in their efforts to foster broader participation in value-based care arrangements, thereby enhancing the lives of patients and families across the United States."

The three-organization workgroup that developed the playbook included participants from national and regional health plans, diverse physician practices, and multiple VBC entities, including but not limited to ACOs.

AHIP, AMA, and NAACOs released its first playbook in conjunction with a webinar featuring leaders from all three organizations:

• Danielle Lloyd, SVP-Private Market Innovations & Quality Initiatives at AHIP
   
• Carol Vargo, VP-Practice Sustainability at the AMA
   
• Aisha Pittman, SVP-Government Affairs at NAACOs

While these three stakeholder groups have unique needs, focusing on five best practices for data-sharing — quoted directly from the playbook with webinar quotes highlighted throughout:

1. Create an Interoperable Data Ecosystem: Adopt consistent content and exchange standards to simplify and expand data sharing.
   
   On this best practice, AHIP's Lloyd noted: "Both plans and providers have different levels of experience and capabilities. We talk about alignment but there is no uniformity. We have to meet our partners where they are. For example, some provider offices don't have access to certified EHRs, so we have to think about how to incrementally implement some of these best practices."
   
   Pittman with NAACOs echoed these points: "EHR interoperability is still a challenge that ACOs are facing. Some workarounds are using third-party applications to combine data where feasible, but more work is needed to better align and combine data elements."
    
2. Share More Complete, Comprehensive Data: Empower value-based care participants with complete, accurate, and consistent data that paints a more comprehensive picture of a patient or population.
   
   Speaking to this best practice, Pittman asked: "What do you do when complete information cannot be shared?" The NAACOS SVP further cited the need for "aggregate or contextual data to promote and build transparency and ultimately trust."
    
3. Improve Data Collection and Use to Advance Health Equity: Collect and share data to identify and address health disparities as well as barriers to care beyond the clinical setting, while ensuring transparency, appropriate use, and confidentiality.
   
   Examples provided by Lloyd include stratification around demographics, more granular options, national standards, and the ability to act on individual and shared data.
    
4. Share Timely, Relevant, and Actionable Data: Prioritize sharing focused insights and data early, often, and in accessible ways to improve care.
   
   For this best practice, Pittman noted that data must be "presented in a way that can be leveraged to help make decisions. Clinical data needs to be available at point of care … [with] adequate attribution data available frequently."
    
5. Make Data Methodologies, Calculations, and Context Readily and Easily Available: Share detailed information on how and what data were derived from to foster trust among value-based care participants in the data they receive, use, and by which performance is measured.
   
   A phase two playbook on payment methodology will follow these data-sharing best practices.
    

Obstacles to implementation

Best practices are one thing. Implementing them successfully is another if more providers are to participate in VBC arrangements.

Largo, VP with the AMA, noted that physicians need three things to participate: infrastructure, including data analytics); stable and transparent reimbursement, including a stemming payment rate erosion; and less administrative burden.

"Many practices have 10+ payer contracts. These should be aligned to aid VBC participation and create a better on-ramp."

Pittman and Lloyd agreed, adding that the impact of turbulent provider finances and workforce issues has sparked interest in achievable VBC arrangements. Lloyd stressed "the importance of the upfront investments" needed for VBC, that providers have looked to acquisition for these resources, and that that represents real risks.

"We've seen a lot of new entrants into the market [acquiring practices] that aren't necessarily interested in value. Our goal is to really ensure that physician practices are able to participate and stay independent if they want because I think some of the consolidation issues that we're seeing are troublesome."