What’s the news: The AMA and other major stakeholders are setting forth data-sharing best practices to support a sustainable future for value-based care.
The AMA, the health insurer trade group AHIP, and the National Association of ACOs released a playbook to advance the adoption of value-based care arrangements in the private sector that could have a greater impact on the quality and equity of care and ease participation by fostering voluntary alignment of data-sharing practices.
While recognizing that different entities have inherently varying needs and uses for data, in working together the AMA and the other stakeholders discovered five key areas of opportunity to:
- Create an interoperable data ecosystem: Adopt consistent content and exchange standards to simplify and expand data sharing.
- 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.
- 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.
- Share timely, relevant and actionable data: Prioritize sharing focused insights and data early, often, and in accessible ways to improve care.
- 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.
In addition to best practices, the playbook spotlights promising practices, recognizing the need to meet practices where they are in their journey to value. The playbook also explores challenges preventing more widespread data sharing and interoperability across systems and reviews several ongoing initiatives by industry to attempt to overcome these barriers and establish core data-sharing standards.
The partners are also exploring future potential collaboration to examine various aspects of value-based care arrangements that could benefit from further alignment around principles and best practices—including payment methodologies, specialty-primary care coordination, actionable quality metrics, patient engagement, and care delivery.
Why it’s important: Even with nearly two decades of experience implementing value-based care models, the COVID-19 pandemic underscored many of the persistent challenges facing the U.S. care delivery system, such as inequities in care and access, data exchange and availability, and misaligned payment incentives.
The playbook is intended to give health insurance providers, physicians and other health professionals, and value-based care entities with access to best practices informed by real-world experiences to help guide, in a voluntary manner, considerations for the design, implementation and evaluation of potential future arrangements that accommodate participants with a range of experience.
Over the past several months, the AMA and the other stakeholders convened an advisory workgroup of members from each association, established a managing committee of association leaders, directed a robust literature review and environmental scan, and conducted interviews with subject-matter experts. Participants were selected through an intentional process to ensure diverse representation including national and regional health plans; large, small, rural, integrated and independent physician practices; and value-based care entities such as accountable care organizations (ACOs).
“This is not a product produced in the ivory tower. Rather, this playbook reflects the contributions from physicians on the front lines of implementation, across all practice settings—small, independent to large integrated systems. These physicians had a range of diverse experiences with VBC arrangements. Working together, they came up with a plan to improve patient care going forward. That teamwork, often seen in the clinical setting, proved invaluable in this setting as well," said AMA President Jesse M. Ehrenfeld, MD, MPH.
The new playbook marks the beginning of an ongoing partnership among these three leading industry voices to explore how to sustain momentum for and grow broad-based participation in value-based care arrangements to improve the lives of patients and families throughout the U.S.
The playbook also highlights outstanding examples of data-sharing best practices by members of the AMA Health System Program such as Ochsner Health and Privia Health.
Learn more: With the first pillar of the AMA Recovery Plan for America’s Physicians, the AMA has challenged Congress to work on systemic reforms and make Medicare work better for you and your patients. Among these are critical changes that are needed to enhance physician participation in alternative payment models (APMs), improve patient outcomes and cut unnecessary Medicare spending.
In news related to the future of value-based care in the U.S., the AMA applauded last month’s introduction of the Value in Health Care Act (PDF), a crucial bipartisan bill that will continue the 5% APM incentive payments for two years.
The bill also would freeze the 50% revenue threshold that physicians in value-based care models must meet to qualify for these bonuses over the same time frame and give the Department of Health and Human Services more flexibility to adjust financial risk levels to better accommodate different types of models and at a pace that enables more physicians, particularly safety net and rural providers, to take part in APMs.