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Despite the growth of commercial gain-share—also known as Accountable Care Organization (ACO)—arrangements, a lack of consistent contract structures and terms has hampered the adoption of value-based care. This is particularly true for independent physicians, only 34 percent of whom enter commercial gain-share arrangements. National payers have unanimously voiced their goal to move towards value-based arrangements. To be successful, these efforts must engage the nearly one out of every three physicians who identify as an independent provider. This post proposes a principle-driven approach to align the incentives of payers and providers to facilitate greater adoption of new value-based payment models and to avoid common pitfalls in ACO contract negotiations.
Payer Value-Based Contracting Goals
The Affordable Care Act created the Medicare Shared Savings Program (MSSP) with the goal of reducing costs and improving the health and care of Medicare beneficiaries. Private payers quickly ramped up their own versions of MSSP with significant investments. We have held in-depth conversations with every national payer and each intends to shift their medical spending towards value-based arrangements similar to MSSP. Aetna and Anthem participate in the Health Care Transformation Taskforce which aims to place 75 percent of spending in value-based arrangements by 2020…