Insurers, Physicians, Providers & ACOs Release Playbook to Advance Value-Based Care

This week, America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of ACOs (NAACOS)  released a playbook on voluntary best practices as part of their efforts together to advance the adoption of value-based care arrangements in the private sector to improve the quality, equity, and affordability of care.

In an effort to manage consideration of the many elements of VBC payment arrangements, the workgroup focused its examination and discussion on total cost of care (TCOC) models. AHIP, AMA, and NAACOS commissioned a thorough literature review, an environmental scan, and interviews with subject matter experts. They formed an advisory workgroup composed of members of each association, which met throughout the fall of 2023.

The resulting playbook, Creating a Sustainable Future for Value-Based Care articulates voluntary best practices on key payment domains including:

• Development of patient attribution methods
• Establishment of financial benchmarks
• Methods to ensure risk adjustments appropriately reflect the health of the attributed patient populations.

Clif Gaus, Sc.D., president and CEO of the National Association of ACOs,

This iteration of the playbook synthesizes what we’ve learned over the last decade plus, so that payers, physicians, hospitals, and ACOs can implement payment and delivery models that improve outcomes and lower costs.

Mike Tuffin, President and CEO at AHIP,

This partnership among key stakeholders brings to the forefront voluntary best practices for aligned models that can streamline operations and build resiliency to expand access to high-quality, equitable and affordable value-based care.

The 74 page playbook recognizes that there is no single recommendation for the best value-based care arrangements, its voluntary best practices were sourced from the direct experience of physicians, value-based care entities, and health plans. The insights are organized into seven domains:

1. Payment Attribution, determining which patients and their associated medical costs that physicians or entities are accountable for.​
2. Benchmarking, setting financial targets to compare to spending over a particular year.
3. Risk Adjustment, accounting for the relative sickness of patients. ​
4. Quality Performance Impact on Payment, rewarding entities for performance on quality on a set of metrics.​
5. Levels of Financial Risk, assuming some level of financial responsibility, if and when appropriate, for improving outcomes and costs of patients.​
6. Payment Timing & Accuracy, structuring how and when funds flow in arrangements. ​
7. Incentivizing for Value-Based Care Practice Participant Performance, considering how to educate and reward participants in achieving the goals of payment arrangements.​