AHIP, AMA, NAACOS Release Playbook on Sustainable Future for Value-Based Care

AHIP, the American Medical Association (AMA), and the National Association of ACOs (NAACOS) announced the release of data sharing best practices that organizations may voluntarily adopt to support a sustainable future for value-based care (VBC). The playbook, The Future of Sustainable Value-Based Care and Payment: Voluntary Best Practices to Advance Data Sharing, is intended to advance the adoption of VBC arrangements in the private sector that could have a greater impact on the quality and equity of care and ease participation by fostering voluntary alignment of data sharing practices.

Even with nearly two decades of experience implementing VBC models, the COVID-19 pandemic underscored many of the persistent challenges facing the U.S. care delivery system, such as disparities in care and access, data exchange and availability, and misaligned payment incentives. The playbook is intended to provide health insurance providers, physicians and other health professionals, and VBC entities with access to best practices informed by real-world experiences to help guide, in a voluntary manner, considerations for the design, implementation, and evaluation of potential future arrangements that accommodate participants with a range of experience.

“When diverse minds and perspectives collaborate, the true potential of value-based care emerges,” said Matt Eyles, AHIP President and CEO. “The playbook represents collective effort and shared responsibility, with the goal of reshaping the health care landscape, empowering patients, reducing operational burden, and driving positive change.”

This marks the beginning of an ongoing partnership among three leading industry voices to explore how to sustain momentum for and grow broad-based participation in VBC arrangements to improve the lives of patients and families throughout the U.S. The first phase of this effort focused on data sharing as a fundamental building block of VBC operations.

“The success of value-based care hinges on delivering the best care, in the proper setting, at the right time,” said Clif Gaus, Sc.D., president and CEO of the National Association of ACOs. “To do that, clinicians need timely, actionable data. Our recommendations for both policy and private industry data sharing aim to ensure sustained success and growth of value-based care.”

Over the past several months, the partners convened an advisory workgroup of members from each association, established a managing committee of association leaders, directed a robust literature review and environmental scan, and conducted interviews with subject matter experts. Participants were selected through an intentional process to ensure diverse representation including national and regional health plans; large, small, rural, integrated, and independent physician practices; and VBC entities, such as accountable care organizations (ACOs).

“This is not a product produced in the ivory tower. Rather, this playbook reflects the contributions from physicians on the front lines of implementation, across all practice settings—small, independent to large integrated systems. These physicians had a range of diverse experiences with VBC arrangements. Working together, they came up with a plan to improve patient care going forward. That teamwork, often seen in the clinical setting, proved invaluable in this setting as well,” said AMA President Jesse M. Ehrenfeld, M.D., MPH.

While recognizing different entities have inherently varying needs and uses for data, five key areas of opportunity emerged:

1. Create an Interoperable Data Ecosystem: Adopt consistent content and exchange standards to simplify and expand data sharing
2. Share More Complete, Comprehensive Data: Empower value-based care participants with complete, accurate, and consistent data that paints a more comprehensive picture of a patient or population.
3. Improve Data Collection and Use to Advance Health Equity: Collect and share data to identify and address health disparities as well as barriers to care beyond the clinical setting, while ensuring transparency, appropriate use, and confidentiality.
4. Share Timely, Relevant, and Actionable Data: Prioritize sharing focused insights and data early, often, and in accessible ways to improve care.
5. Make Data Methodologies, Calculations, and Context Readily and Easily Available: Share detailed information on how and what data were derived from to foster trust among value-based care participants in the data they receive, use, and by which performance is measured.

The partners are exploring future potential collaboration to examine various aspects of VBC arrangements that could benefit from further alignment around principles and best practices—including payment methodologies, specialty-primary care coordination, actionable quality metrics, patient engagement, and care delivery.