Health care organizations collaborate on best practices for value-based care

On April 10, 2024, AHIP, the American Medical Association and National Association of ACOs announced a new playbook for payment arrangements in value-based care.
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A new volume outlines the best ways to find success as health care entities integrate value-based care arrangements into their operations.

The American Medical Association, the National Association of ACOs (NAACOs) and AHIP, the trade group representing America’s health insurance payers, collaborated to publish “Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements.” The 74-page guide was announced April 10, the day before NAACOs’ two-day spring conference begins.

“In the last decade, value-based care has grown from almost nothing to undeniably significant aspect of our health system,” including accountable care organizations making up 20% of Medicare, said NAACOs President and CEO Clif Gaus, ScD, said in a statement. “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 lowers costs.”

The organizations announced they are collaborating on the Future of Value Initiative to share voluntary best practices with three aims:

• Enhance patient experience
• Improve population health
• Reduce cost

“Getting important aspects of value-based payment right is crucial for continuing to advance physicians’ success in helping their patients achieve good health outcomes in these models,” AMA President Jesse M. Ehrenfeld, MD, MPH said in a statement. “This playbook reflects input from physicians in an array of practice settings on their lessons learned for patient attribution and financial risk and benchmarking. It will be a valuable resource for both those with experience in value-based care and those who are just getting started.”

The best practices were compiled by Aurrera Health Group and Coral Health Advisors, based on insights from leaders of national and regional health plans; large small, rural, integrated, and independent physician practices; and value-based care entities, such as accountable care organizations.

The playbook covers seven domains. The organizations’ announcement described them:

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

The guidebook cited research documenting growth of value-based care arrangements in recent years.

For example, 24.5% of all medical care is in two-sided financial risk arrangements, up 5% from 2022, according to a 2023 report of the Health Care Payment Learning and Action Network. The guidebook cited Institute for Accountable Care findings that 75% of organizations participating in traditional Medicare ACO value-based care payment arrangements also had value-based care payment arrangements with Medicare Advantage or commercial plans, and more than 30% had such arrangements in Medicaid. Those figures are up from earlier surveys dating back to 2018.

“Overcoming recent challenges to the expansion of value-based care arrangements requires focused and sustained collaboration across the system,” AHIP President and CEO Mike Tuffin said in the organizations’ announcement. “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 guidebook follows the organizations’ July 2023 announcement of “The Future of Sustainable Value-Based Care and Payment: Voluntary Best Practices to Advance Data Sharing.” That guidebook recommended ways for transferring information to improve patient care.