Payers, Providers

AHIP, AMA, NAACOS Release Playbook for Value-Based Care

AHIP, the AMA and NAACOS released a playbook last week that provides the best practices for value-based care. It is based on experiences from physicians, value-based care entities and payers.

As the healthcare industry works to move away from the fee-for-service system, three healthcare stakeholders have teamed up to release a playbook that details the best practices for value-based arrangements.

The three organizations are AHIP, the American Medical Association (AMA) and the National Association of ACOs (NAACOS). AHIP represents health insurers, while the AMA represents physicians. NAACOS is a nonprofit of more than 430 ACOs in Medicare, Medicaid and commercial insurance.

The playbook, released last week, is part of the Future of Value Initiative, which is focused on improving the patient experience, advancing population health and lowering costs. The playbook was created based on the “direct experience of physicians, value-based care entities and health plans,” according to a news release. It provides recommendations organized by seven domains: patient attribution, benchmarking, risk adjustment, quality performance impact on payment, levels of financial risk, payment timing and accuracy, and incentivizing for value-based care practice participant performance.

“We really wanted to step back and really assess the lessons learned so far, take some fresh eyes, look at building these best practices that are really rooted in real-world experience from our friends here so that we can really inform the sustainable models for the future,” said Danielle Lloyd, senior vice president of private market innovations and quality initiatives at AHIP. She made these comments during a panel discussion at the NAACOS Spring 2024 Conference held last week.

Summarizing these lessons learned will help payers, physicians, hospitals and ACOs “implement payment and delivery models that improve outcomes and [lower] costs,” said Clif Gaus, president and CEO of NAACOS, in a statement.

To create the playbook, the partners assembled an advisory workgroup comprising members from each association and held interviews with subject matter experts. Participants were purposely chosen to encompass a diverse range of individuals with different backgrounds in implementing value-based care models, according to the announcement. This included representatives from national and regional health plans, large and small physician practices in rural and urban areas, and value-based care entities.

“Getting important aspects of value-based payment right is crucial for continuing to advance physicians’ success in helping their patients achieve good health outcomes in these models,” said Dr. Jesse Ehrenfeld, president of the AMA, in a statement. “This playbook reflects input from physicians in an array of practice settings on their lessons learned for patient attribution and financial risk and benchmarking.”

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The release of the playbook follows another playbook released in July by the three organizations that focused on the best practices for data sharing. In the future, the groups will “consider exploring other possible aspects of value-based care arrangements that could benefit from the publication of voluntary best practices,” the announcement stated.

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