01 Sep Building Successful Value-Based Partnerships
The Health Care Transformation Task Force (HCTTF or Task Force) is committed to developing resources designed to help both beginner and advanced organizations realize their full potential in transforming to a value-based health care system. Below, existing HCTTF resources are categorized for ease of reference. We encourage you to consult these resources as you build out your value-based enterprise.
Organizational Commitment to Value Transformation
- Transformation to Value: A Leadership Guide: Health care industry leaders face incredible challenges in shifting from traditional, volume-driven fee-for-service to value-based payment and care delivery. This Leadership Guide provides a framework to help guide decision makers in their transformation journeys, along with insights from organizations at the vanguard of value.
Partnerships between Payers and Providers
Assessing Potential Partners
- Partnership Evaluation Tool: This Tool supports leaders as they evaluate potential partner organizations for readiness to engage in successful value-based partnerships. This interactive Tool is designed around a set of core competencies determined to be necessary for successful partnerships; it can also serve as a self-assessment tool for organizations to benchmark their own readiness to enter into risk arrangements and track areas for improvement.
Implementing Successful Partnerships
- Alternative Payment Model (APM) Roles and Responsibilities Matrix: This Tool supports payer, provider, and purchaser efforts to clearly identify and assign roles and responsibilities for common APM workstreams by identifying the relationships between the parties implementing the APM, recognizing caps or overlaps in responsibilities, improving efficiencies and communication, and promoting successful operations. The resource guide and Excel-based matrix cover the most common APM activities and can be customized to reflect a user’s specific APM or integrated into existing organizational project management plans.
Value-Based Payment Models
- Principles for Clinical Episode and Population-Based Payment Overlap: These guiding principles govern the development of best practices in public and private payer clinical episode models.
Accountable Care Organizations
- Accountable Care Financial Arrangements: Options and Considerations: This report offers a comprehensive look at the seven predominant payment models currently used by accountable care organizations. It describes each type of payment arrangement, notes which payers and provider organizations use it, and outlines the level of risk transfer, as well as the opportunities and challenges unique to each arrangement.
- Levers of Successful ACOs: This report highlights high-performing Accountable Care Organizations (ACOs) to assess structures and strategies that led to their success. While each organization had differing approaches and experiences, common themes emerged in three major categories: (1) Achieving High-Value Culture, (2) Proactive Population Health Management, and (3) Structures for Continuous Improvement.
- Episode Groupers: Key Considerations for Implementing Clinical Episode Models: This paper examines episode groupers and clinical episode payments and provides key insights within context of the following four categories: (1) defining the focus and duration of the episode, (2) differentiation across patient groups, (3) differentiation between subgroups within similar diagnosis groups, and (4) attributing services and costs to the episode.
- What’s in a Name: A Primer of Global Budget Models: This paper is a primer on global budget models which identifies a set of common characteristics, outlining different model types and detailing common elements. Several existing global budget models are also described.
- Key Elements to Consider in ACO Agreements: This guidance is an educational resource for the health care community and focuses on contracting strategies in three main areas: (1) patient experience and access; (2) cost; and (3) quality of care.
- Clinical Episode Contracting Guidance for Commercial Payers: This guidance provides an objective tool for payers and providers to work together to make key program and contract design decisions in a logical, step-wise way. It also includes links to key resources that can assist organizations in pursuing specific design elements.
- Care Management Contracting for High Need High Cost Populations: This resource is designed to help provider and payer organizations effectively contract for high-need, high-cost programs. The resource includes a whitepaper that shares information and recommendations regarding a range of different care models and contracting approaches; and a practical set of guidelines to providers and payers develop contracts that incorporate reimbursement for high-need, high-cost individuals. This resource was developed in collaboration with the Pacific Business Group on Health with financial support from the Commonwealth Fund and the SCAN Foundation.
- Addressing Consumer Priorities in Value-based Care: This framework aids systems in ensuring consumer priorities remain front and center during all phases of the transformation to a value-based care system. The framework includes six principles, including (1) include patients/consumers as partners in decision-making at all levels of care, (2) deliver person-centered care, (3) design alternative payment models (APMs) that benefit consumers, (4) drive continuous quality improvements, (5) accelerate use of person-centered health information technology, and (6) promote health equity for all.
- Consumer Engagement Structures and Mechanisms: This guidance represents output from an environmental scan and survey that helped identify consumer engagement structures and mechanisms utilized by provider organizations in the design and governance of value-based payment programs.
- Organizational Level Consumer Engagement: What It Takes: This case study report explores what it takes for health systems to meaningfully engage patients and their families in governance and operational decision-making, highlighting engagement efforts at three organizations – HRHCare, Children’s Mercy Kansas City, and Trinity Health. This paper was developed in collaboration with Community Catalyst with support from the Robert Wood Johnson Foundation. As a result of this project, HCTTF and Community Catalyst developed a web-based change package, Organizational Level Consumer Engagement: Implementing and Sustaining Successful Strategies. The change package is meant to serve as a guide for health systems seeking to improve and develop meaningful person-centered engagement structures at the organizational level and includes key action steps, self-assessment questions, useful resources for designing, implementing, and scaling engagement strategies.
- Engaging Consumers in Care Delivery: HCTTF created an implementation This framework provides guidance for engaging consumers in their care delivery. The Framework is organized around three core elements of care that engage patients, including: (1) coordination of care and systems of care, including physical/mental health and social services, (2) shared and empowered decision-making, and (3) individual activation for self-management.
- Consumer Engagement in Benefit Design: This set of six principles is designed to help guide payers, purchasers, and providers in their efforts to better integrate consumer needs and preferences into insurance benefit design, promoting a holistic consumer experience.
- Principles for Consumerism in Value-Based Care: This set of seven principles aims to ensure consumerism approaches are patient-centered and equitable and therefore reflect approaches which truly empower patients as partners in their care.
Partnerships with Public Health & Social Services
- Partnering to Catalyze Comprehensive Community Wellness: This framework is designed to help catalyze and facilitate collaborative working relationships between the public health and health care sectors and outlines essential elements of collaboration and presents key tactics and strategies for forming or reshaping effective partnerships. HCTTF developed with framework in collaboration with the Public Health Leadership Forum with support from the Robert Wood Johnson Foundation.
- Social Services Integration Framework: This framework challenges organizations to think beyond traditional clinical settings and to simultaneously address social needs and social determinants of health that affect population health. It helps organizations identify their target population, understand the available resources, and develop an effective integration model.