Building a Bridge to Value

It’s no secret that the dominant model of reimbursement and compensation in health care today presents many opportunities for improvement. That model, fee-for-service (volume), rewards high volume care: many office visits per day, lots of tests, lots of screenings, lots of procedures. It does not adequately promote the values of health care that we see represented in the Quadruple Aim or the goal of providing the right care at the right time at the right place.
MaineHealth and its partners created the MaineHealth ACO to help make the transition away from fee-for-service and toward value-based care reimbursement that rewards appropriate utilization, higher quality and healthier populations. We use value-based contracts with Medicare, MaineCare and our private health plan partners as the primary mechanism for easing the transition forward. In these contracts, the ACO and participating providers agree to certain cost and quality targets for the care they deliver to health plan beneficiaries. When those targets are achieved, the savings that results is shared between the payer (Medicare or a private insurer) and the ACO.
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Growth of Value-Based Agreement BeneficiariesBeneficiaries
Year-over-year, the ACO has steadily grown its value-based portfolio. The ACO’s initial agreements in 2011 covered slightly over 34,000 beneficiaries. In 2017, that number has increased five-fold to 215,000. Today, the ACO maintains 16 value-based agreements with a total of 11 payers. These include forward-thinking private health plans that invest in our shared vision of a value-based future.
The success of these agreements shows that the ACO is on a steady march toward higher value care. This is best illustrated by our participation in the Medicare Shared Savings Program (MSSP), the value-based reimbursement model for Medicare beneficiaries. MSSP statistics show that our expenditure per beneficiary is more than eight percent lower than the rate for fee-for-service Medicare beneficiaries nationally. We’ve achieved this lower expenditure rate while also increasing quality. Our quality score, as measured by MSSP, has improved year-over-year from 91 percent in 2014 to 97.3 percent in 2016.
Looking forward, we plan to further speed the transition away from volume and toward value by entering into a MSSP contract that includes downside risk. Downside risk introduces a financial penalty if quality and cost targets are not achieved. By raising the financial stakes, such an arrangement will increase the urgency of achieving higher value care, transforming care delivery in the best way possible for our patients.

Building a Bridge to Value

It’s no secret that the dominant model of reimbursement and compensation in health care today presents many opportunities for improvement. That model, fee-for-service (volume), rewards high volume care: many office visits per day, lots of tests, lots of screenings, lots of procedures. It does not adequately promote the values of health care that we see represented in the Quadruple Aim or the goal of providing the right care at the right time at the right place.
MaineHealth and its partners created the MaineHealth ACO to help make the transition away from fee-for-service and toward value-based care reimbursement that rewards appropriate utilization, higher quality and healthier populations. We use value-based contracts with Medicare, MaineCare and our private health plan partners as the primary mechanism for easing the transition forward. In these contracts, the ACO and participating providers agree to certain cost and quality targets for the care they deliver to health plan beneficiaries. When those targets are achieved, the savings that results is shared between the payer (Medicare or a private insurer) and the ACO.
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Growth of Value-Based
Agreement Beneficiaries
Beneficiaries
Year-over-year, the ACO has steadily grown its value-based portfolio. The ACO’s initial agreements in 2011 covered slightly over 34,000 beneficiaries. In 2017, that number has increased five-fold to 215,000. Today, the ACO maintains 16 value-based agreements with a total of 11 payers. These include forward-thinking private health plans that invest in our shared vision of a value-based future.
The success of these agreements shows that the ACO is on a steady march toward higher value care. This is best illustrated by our participation in the Medicare Shared Savings Program (MSSP), the value-based reimbursement model for Medicare beneficiaries. MSSP statistics show that our expenditure per beneficiary is more than eight percent lower than the rate for fee-for-service Medicare beneficiaries nationally. We’ve achieved this lower expenditure rate while also increasing quality. Our quality score, as measured by MSSP, has improved year-over-year from 91 percent in 2014 to 97.3 percent in 2016.
Looking forward, we plan to further speed the transition away from volume and toward value by entering into a MSSP contract that includes downside risk. Downside risk introduces a financial penalty if quality and cost targets are not achieved. By raising the financial stakes, such an arrangement will increase the urgency of achieving higher value care, transforming care delivery in the best way possible for our patients.