Health Care Transformation Task Force is an industry consortium that brings together patients, payers, providers and purchasers to align private and public sector efforts to clear the way for a sweeping transformation of the U.S. health care system. We seek to provide a critical mass of business, operational and policy expertise from the private sector that, when combined with the efforts of the Centers for Medicare & Medicaid Services and other public and private sector stakeholders, can accelerate the pace of delivery system transformation.
What Makes Us Different
Our members represent every sector of health care. While at times we have competing interests, we share a common commitment to transform our business and clinical models to deliver the Triple Aim of better health, better care and lower costs. Our outputs will not reflect the simple self-interest of any one organization or market segment, but rather agreement on common private and public approaches that will best facilitate transformation.
We believe so strongly in our mission that our payer and provider members commit to put 75 percent of their respective businesses operating under value-based payment arrangements that focus on the Triple Aim by January 2020. Our purchaser and patient members commit to creating and sustaining the demand, support and education of their constituencies necessary to reach this goal.
There is a vital need for the industry to work cooperatively to accelerate health care transformation and position it for success. We need to overcome doubts about the certainty and pace of the transition and improve our knowledge about how to best produce the Triple Aim of better health, better care and lower costs. We need to make individuals and families aware of and involve them in health system redesign. If we want providers and payers to commit to this transformation, we must offer certainty that the nation will stay the course. Finally, we must ensure that the transition does not decrease competition across the industry.
Our Work Groups and Advisory Groups
We will develop timely and actionable policy and program design recommendations for the private sector, the Centers for Medicare & Medicaid Services (CMS), Congress and others; new delivery and payment models; and the best-practice tools, benchmarks and approaches to implement them through our targeted workgroups. Initial priorities include improving the Accountable Care Organization (ACO) model, developing common bundled payment framework and improving care for high-cost patients.
We will develop aligned public-private action steps and recommendations to improve the design and implementation of the ACO model in commercial, Medicaid and Medicare programs, including through an organized and coordinated response to the upcoming Medicare Shared Savings Program proposed rule.
Our contributions include:
- Policy recommendations for CMS focusing initially on improving patient attribution, financial stability, quality measurement and patient engagement.
- Publishing best practices for ACOs addressing improving patient attribution, financial stability, quality measurement and patient engagement.
Bundled Payment Workgroup
We will identify and evaluate existing episode-based bundled payment models according to collectively developed criteria and desired outcomes. Based on the evaluation exercise, we will coalesce as a workgroup around best-practice models that companies can work to implement.
Our contributions include:
- Conducting an environmental scan of all bundled payment approaches being used in the private and public sectors.
- Developing evaluation criteria for measuring the open source and proprietary bundle definitions.
- Developing a KLAS-like comparative profile of current bundled payment options.
High Cost Patient Workgroup
We will identify and evaluate key areas that drive costs for patients in health care systems.
Our contributions include:
- Addressing risk stratification of high cost patients and implementation of programs to perfect handoffs and improve coordination among high-risk integration care programs and assure patient/family-centric care, better outcomes, and lower costs.
- Discussing, developing and disseminating best practices for identifying and improving care for:
- Patients at the end of life.
- High-cost events.
- Patients with multiple chronic disease, including those with underlying chronic behavioral health, where traditional disease and case management is not effective.
We will provide a reservoir of consumer voices to inform the Task Force, its workgroups, and all Task Force work products in our collective pursuit of person-centered, value-based health care.
Our contributions include:
- Developing and providing specific guidance that other workgroups can use to ensure that consumer priorities are reflected in all Task Force work products.
- Providing expertise about how execution of consumer priorities and partnership with consumers at all levels of care delivery can help enhance empowered consumer engagement in their own health and health care.
Advisory Group for Consumer Priorities
We will address both internal practical/operational challenges of health care organizations moving toward broad adoption of value-based payment systems and the external market-place dynamics that challenge transformation efforts for the health care system as a whole. We will develop practical solutions, perspectives, and approaches and share learnings that will facilitate members' reaching the goal of 75 percent of businesses being in value-based arrangements meeting the Triple Aim.
Path to Transformation Advisory Group
- We commit to have 75 percent of our respective businesses operating under value-based contracts payment arrangements that focus on the Triple Aim by January 2020 and call on the rest of the health system to do the same.
- Value-based delivery and payment systems must be designed to deliver the Triple Aim.
- We define value-based arrangements as those which successfully incentivize and hold providers accountable for the total cost, patient experience and quality of care for a population of patients, either across an entire population over the course of a year or during a defined episode that spans multiple sites of care.
- Health care costs should not continue to crowd-out other vital national investments. Growth in total health costs, both public and private, should be at or below the overall rate of GDP growth.
- All payers – public and private – should use the full extent of their capabilities and authority, including that provided to the U.S. Secretary of Health and Human Services, to make successful models national policy.
- Meaningful competition should expand and not contract during this transition. We recognize and accept that there will be winners and losers in a value-driven system. We seek to help equip as many market participants as possible with the information and tools they need to compete fairly.
- Value-based service delivery and payment systems should promote individual and family participation and engagement at all levels of system redesign and governance – from point of care to redesign of care delivery, to governance and oversight.
- The foundation of value-based service delivery and payment systems is people-centered coordinated care – with robust primary care capabilities at its center – that is accountable for Triple Aim outcomes.
- Any savings achieved through population health models should be shared among people, payers/purchasers and providers to ensure adequate investment in new care models.
- Private and public payers must recognize that this effort will take years and they cannot expect to recover all investments in the short term. We need to make sure that providers can recoup reasonable returns on investments in care coordination by setting performance standards lower at the outset to draw in as many players as possible, raising the bar gradually, yet consistently, over time.
- Value-based payment and delivery models should meet the needs of disadvantaged populations and strengthen the safety net providers who serve them.
- Alignment among public and private payers is critical. Providers cannot reasonably transition away from fee-for-service if payers take a piecemeal approach to transformation that does not engage the vast majority of their payers. Common accountability targets, metrics and incentives across payers is essential, and will allow for meaningful comparability and true best practice identification.
- Data is essential to driving the success of care coordination and should be provided at a sufficiently granular level by those private and public entities currently holding it to allow for standardized and ad hoc reporting by care coordinating entities. Additionally, a sufficient infrastructure for the secure, privacy-protected exchange of health information must be created through private-public partnership – including through public policy – to ensure the full promise of health system transformation.
- Value-based systems should promote transparency of quality and cost metrics in a manner that is accessible to, and easily understood by, consumers. Transparency should foster provider accountability and quality improvement, while enabling consumers' and purchasers' ability to compare information on outcomes, care experience, total cost of care and consumer out-of-pocket expenses.