Premier Offers Healthcare Policy Improvements for ACOs, Payers

December 07, 2016 - Earlier this year, the provider alliance organization Premier Inc. announced in a company press release a number of recommendations meant to improve the framework of healthcare policy.

The key points meant to improve the creation of healthcare policy push forth more cost-effective and high quality medical services. One area of improvement that Premier emphasizes is the need to strengthen the Medicare Shared Savings Program to boost the population health outcomes from accountable care organizations (ACOs).

The list of ways to improve the Medicare Shared Savings Program includes creating permanent payment waivers, bring extra shared savings for the best performing providers, and allowing for more flexibility when Medicare ACOs move up the risk continuum ladder.

Private payers operating accountable care organizations can also implement some of these suggestions to enable well-performing providers and position more financial risk onto their ACOs.

“The ultimate goal of healthcare reform should be a consumer-centered and healthcare provider-driven system that holds providers accountable for the total cost, quality and experience of care for a population,” Premier’s Delivery System Transformation Roadmap stated. “Medicare and Medicaid payment systems should be designed that incent providers to form jointly governed organizations to share risk and provide comprehensive, coordinated care together rather than competing across provider types.”

“This is a time of enormous investment by healthcare providers in health data technology, new care delivery models and programs to assure the health and well-being of the communities they serve should a disease or crisis occur. With these ongoing challenges, it is important that policymakers avoid one-off policy approaches without considering the holistic impact during this time of change.”

Data access is another key area Premier’s recommendations focused on. Both public and private payers can work with providers to ensure clinicians receive timely medical data access to improve healthcare decision-making. Payers can also use claims and clinical data to strengthen population health management and preventive care, which may help lead to a decline of healthcare spending growth.

Premier recommends a number of public agencies including Medicare, Medicaid, the Veteran’s Administration and the Department of Defense to have access to real-time medical data for better quality of care while also ensuring patient privacy and security standards are followed.

Another way to improve healthcare policy is to create a “blended payment model pilot,” Premier suggests. This could analyze the benefits of using primary care capitation along with bundled payment platforms among Medicare accountable care organizations. Private payers could also benefit by improvising new alternative payment models within the value-based care realm.

To strengthen healthcare policy, public payers may also consider consolidating penalties for hospital pay-for-performance programs so that duplicative penalties are nonexistent. With five separate pay-for-performance programs currently operating, Premier recommends the Centers for Medicare & Medicaid Services (CMS) to consolidate hospital pay-for-performance into one single program.

“While we have come a long way on our journey toward a reformed delivery system with value-based payment models, we’ve also uncovered some unintended consequences,” said Blair Childs, Senior Vice President of Public Affairs at Premier. “Some current policies, while well-intended, are overlapping, confusing and sometimes unfair. Premier’s recommendations present a more comprehensive framework that removes barriers standing in the way of higher quality, more efficient and coordinated care.”

State and federal agencies can also ensure that value-based care reimbursement is available in rural areas. Tailoring payment innovation to low-population density regions and creating pilot programs for value-based care payments can go a long way toward improving patient care in rural locations. Private payers can also innovate in payment reform among rural providers to boost patient health outcomes.

Consumer engagement will remain a key aspect of improving customer loyalty, ensuring higher enrollment numbers, and improving patient wellness. Premier advises public payers to strengthen beneficiary engagement through better cost transparency, benefit design, and payment. This may include incorporating copay waivers, remote monitoring technology, and transportation vouchers.

“With a new Administration and a new Congress coming in 2017, now is the time to hit the reset button and make some common sense changes to the current laws. Enacting these policy reforms will ensure that we continue to build a consumer-driven, accountable healthcare system,” Childs continued. “We look forward to engaging with policymakers and other industry leaders to build on these ideas.”

Private payers could follow the steps outlined by Premier as well as others when attempting to improve consumer engagement. Improving communication channels with customers could lead to better answers to their questions while greater price transparency among payers and providers may bring decreased out-of-pocket spending and greater customer satisfaction.

Patient outreach efforts and the implementation of patient portals could also bring greater consumer engagement, which may lead members to obtain their preventive screenings and follow doctor’s advice for medication adherence, diet, and exercise.

Member portals and user-friendly tools are also advised for stronger consumer engagement. With price transparency becoming sought-after by more and more consumers, effective patient billing systems will also be imperative in strengthening patient retention.

When striving to reach the Triple Aim of Healthcare, reworking the framework for healthcare policy may be imperative especially when it comes to operating accountable care organizations, sharing clinical data with providers, and improving consumer engagement.

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