Accountability = Freedom (To Practice) + Transparency

Is accountable care more than just a buzzword? Even if it is, what can today’s healthcare provider even do about it? Although everyone from the private sector to CMS to the U.S. taxpayer agrees we are spending too much and receiving too little for healthcare, how should providers prepare themselves for this supposed transition to accountable or value-based care? Today, there are patients on the schedule who need care. Tomorrow, there will be more. How is it that our practice or health system should be prepared to provide more cost transparency when we struggle to find our reimbursement transparency? How can we work with insurers and even employer groups to prove we are high-quality providers when we don’t have the data or time to show it?

With the Department of Health and Human Services pledging to pay over 50% of CMS payments through value-based payment models by the end of this year, these questions are running rampant across health systems and private practices across the country. CMS is currently expanding Accountable Care Organization (ACO) incentives, deploying Comprehensive Primary Care Plus (CPC+), and bundled payment for Care Improvement (BPCI) initiatives around the country. Simultaneously, UnitedHealth, Aetna, and Anthem a back in 2017 that nearly 50% of their payments will be tied to value-based models by the end of this year[1]. Despite those realities, most physicians and patients don’t realize they are in such contracts. So, how can we wrap our limited resources around this financially misaligned system that brings an incredibly important threat of an opportunity to today’s provider? Easy, ignore the outside noise for a minute, regardless of your payers’ burdensome quality metrics or CMS’ latest initiatives, and consider this basic equation: Accountability equals freedom plus transparency. It is both a threat and an opportunity; it’s up to you to decide how you’ll approach it.

If physicians are to be held accountable for their patients’ clinical outcomes, the medical cost trend of their patient panel, and their overall “quality” scores, then they simply need the freedom to practice as they would like, and transparency in what they are being held accountable for, plain and simple.

Let’s start with freedom. Physician-led ACOs have shown they can yield better results than larger health systems[2]. Why? The physician leadership provides agility for their fellow physician members by understanding their concerns and proactively seeking to reduce unnecessary workflow additions or activities that don’t add value. If physician members feel free to practice as they know works best, they are more likely to engage with the overall process and offer continuous process improvement feedback to yield practical reports. Although quality metrics and care gaps inherently involve coding stipulations and, initially, unnatural adjustments in routine care, the freedom to decide how to approach those processes is an essential critical success factor.

Once the freedom to practice autonomously is provided, transparently actionable data are the next critically important factor in the accountable care equation. Clinical practice variation is as difficult to discuss as it is to reduce. Whether it’s pharmaceutical orders, surgical equipment utilization, imaging orders, population health metrics, or especially medical cost data, these conversations must be handled delicately. Most physicians not only are not educated in value-based care but also do not have the information necessary to act. If that information takes form in their compensation packages, it might get their attention, but it won’t be the most effective route to engagement. Accurate physician practice variation data that are blinded and presented to promote discussion rather than penalty consistently yield results. Those results include further inquiry into more meaningful metrics, avenues to approach them, and questions as to what physicians believe they should be held accountable for. The absolute key is transparency in both the intentions of collecting this data in a nonpunitive fashion and the clarity upon how aligned physician participation can yield clinical, logistical, and fiscal benefits. Regardless of the contract or CMS program specifics, an effective accountable care organization absolutely must provide transparency and freedom to their physician members.

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[1] https://www.forbes.com/sites/brucejapsen/2017/02/02/unitedhealth-aetna-anthem-near-50-value-based-care-spending/#24697ac71d4e

[2] https://catalyst.nejm.org/do-independent-physician-led-acos-have-a-future/