Accountability for the Accountable Care Organization Movement

Catalyst for Payment Reform Releases First-Ever Tool

for Assessing Health Plan ACOs’ Performance

 

Frustrated by lack of transparency, major employers, other purchasers and benefit consultants spark movement for meaningful information from health plans about their ACOs

BERKELEY, Calif. (December 4, 2017) – Catalyst for Payment Reform (CPR) today called on employers and other health care purchasers to unite in holding health plans accountable for the performance of their accountable care organizations (ACOs) by asking them to report a consistent set of performance metrics to their employer-purchaser customers—as easy to read as a nutrition label.

To drive this change, CPR released a unique set of resources called Standardized Plan ACO Reporting for Customers (SPARC) that employers, state Medicaid, employee and retiree agencies and other health care purchasers can use to assess their health plans’ strategies to use ACOs to improve the delivery of care and make it more affordable. CPR developed SPARC in conjunction with Willis Towers Watson and major health care purchasers to answer growing purchaser demand for greater transparency into ACO design and performance. Purchasers put the onus on health plans because they rely on them as their agents in the market place.

“Purchasers want better, more affordable care for their employees, and ACOs offer a potential way to bend the cost curve while also addressing patient needs more holistically,” said Suzanne Delbanco, Ph.D., executive director of CPR. “Unfortunately, they lack a standard, meaningful way to measure and compare ACO performance, which makes it difficult to justify the additional fees and potential disruption for employees that ACOs can generate. SPARC offers a robust way to dissect and evaluate a health plan’s ACO arrangements so that purchasers know whether they are getting good value for their populations and for their health care spending.”

Health care purchasers are stepping up enthusiastically to use SPARC tools with their health plans in the next two years, including Aircraft Gear Corporation, AT&T, Dow Chemical, Equity Healthcare LLC, Pennsylvania Employees Benefit Trust Fund, Pitney Bowes Inc., and Walmart Stores, Inc. “Any time employers collectively request the same thing, we think we will be stronger if we unify our voice and it will be easier for the health plans to comply,” explained Jennie Pao, Manager of Health Care Planning at Pitney Bowes. Furthermore, Aon Hewitt and Willis Towers Watson plan to incorporate SPARC tools into their advising portfolio available to employer and other purchaser customers.

Since 2011, the number of ACOs has grown from 61 to 923, covering more than 32 million people or approximately 10 percent of the U.S. population. While originally designed as an experimental way to cut costs and improve quality for Medicare, the private sector is rapidly following suit and adopting ACOs. Even so, commercial ACOs have not been subject to the same transparency and evaluation as those serving Medicare. The broad application of SPARC would remedy this deficiency.

“The consistent refrain from purchasers was that health plans were cherry-picking optimal results or delivering metrics that were not meaningful – not only was there a lack of transparency, but there was no way to compare apples to apples,” Delbanco said.

The flagship resource is the Standard Plan ACO Report, inspired by the nutrition label, with a carefully selected set of performance metrics that measure cost, utilization and quality. To enhance standardization, CPR is utilizing metrics from the Integrated Healthcare Association (IHA) and the Pacific Business Group on Health (PBGH) ACO Measurement Set, to which CPR contributed input during development.

The goal is to make the Report an industry standard so that health plans give purchasers what they need—the ability to assess whether these programs are worth the investment, to identify where they need to improve, and to compare them side-by-side. “That will only happen if employer-purchasers demand it, and that starts today,” Delbanco said.

“Walmart believes in the potential of ACOs and is partnering directly with them in certain locations to provide care to our associates. In those cases, we have full information about how they are performing,” said Lisa Woods, senior director of U.S. health care at Walmart. “We also support and expect transparency from our health plans about the ACOs they arrange.”

SPARC in its entirety includes five tools to enhance purchaser oversight:

  • Standard Plan ACO Report: The flagship resource, the Standard Plan ACO Report provides a standard, easy way for purchasers to assess their health plans’ ACO performance—how it impacts the purchaser’s population and spend. The metrics were evaluated and selected by purchasers, and therefore represent those most meaningful to the customer.
  • Request for Information (RFI) Questions: The RFI questions help purchasers gain greater insight into the design of health plans’ ACOs broadly and in specific geographies, and assess health plans’ willingness to use and complete the Standard Plan ACO Report.
  • Model Contract Language: The Model Contract Language sets purchasers’ expectations of their health plans’ ACO strategy and holds health plans accountable for completing and sharing the Standard Plan ACO Report on a regular basis.
  • Performance Guarantees: The Performance Guarantees are sample agreements that purchasers and their health plans can enter into that put the health plan at financial risk for failing to move their ACOs toward shared risk payment arrangements as well as tracking and reporting patient experience of care.
  • Provider Checklist: Purchasers can use the Provider Checklist in direct discussions with an ACO that is important to their population. The Checklist contains questions purchasers can use to gain greater insight into how ACOs are changing the delivery of care and interacting with the purchaser’s health plan to improve quality and contain costs.

 

About Catalyst for Payment Reform

Catalyst for Payment Reform is an independent, non-profit organization working on behalf of large employers and other health care purchasers to catalyze employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace.

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