Transitioning the American healthcare delivery system from one based on fee-for-service reimbursement methodologies to pay-for-value involves a variety of moving pieces. Changing the way we pay for care leads to changes in the way we deliver care, track outcomes, price services, and manage costs. Neither our existing legacy systems nor formal educational programs intended to support these functions contemplated the emerging healthcare environment; few of the adjustments necessary to make these changes are intuitive. The majority of early adopters of alternative payment models (APMs) are learning as they go, creating one-off solutions or manual work-arounds to meet their changing business needs.
To help minimize this steep learning curve, support consistency across the industry and expedite the move to pay-for-value, the Accountable Care Learning Collaborative (ACLC) has convened a cross-section of healthcare industry leaders to create a capabilities assessment tool. The purpose of the tool will be to provide actionable metrics individuals may use to assess their own or their organization’s competency to operate in a value-based world. The ACLC will identify, define and maintain a public inventory of key competencies necessary to succeed under alternative payment models. The Collaborative has identified seven primary domains of competency and will incorporate learnings from a number of other broad-based collaborations, including the following:
HHS program advancing work to increase adoption of alternate payment models
Industry consortium aligning public and private sector towards transformation
Bipartisan expert opinions to inform key decision makers and the public
Health care performance improvement alliance of hospitals and providers
Represents physician organizations practicing capitated, coordinated care
Provider-based organization in NC devoted to sharing lessons re: ACO dev.
National organization of RHICs collaborating to transform healthcare delivery
The following model illustrates the approach ACLC will use to create their assessment tool. Domains are broken down into categories of activities that then lead to specific competences associated with that domain. Each domain has a workgroup chaired by an industry expert and responsible for identifying an initial set of core competencies specific to their domain.
HIMSS has five representatives participating in these efforts. President and CEO Steve Lieber sits on the Governance and Culture domain; HIMSS North America EVP Carla Smith serves on the Financial Readiness domain; Blain Newton, EVP of HIMSS Analytics is engaged in Health IT; Pat Wise, VP of Healthcare Information Systems is on the Quality and Process Improvement and Care Coordination groups; and Pam Jodock, Senior Director of Health Business Solutions is representing us in the Patient Assessment and Determination of Need domain.
The HIMSS APM Infrastructure task force will follow the activities of the ACLC closely, ensure participants of the ACLC are aware of HIMSS activities, and incorporate learnings from this and other efforts into our final recommendations. Please check back with Business Edge frequently for progress reports on the efforts of both the task force and the ACLC.
About the author: Pam has more than 25 years' healthcare industry experience. As the Senior Director of Health Business Solutions for HIMSS, she oversees the overall management and strategy development for HIMSS Health Business Solutions initiatives.