New Framework Provides Direction for Implementing Accountable Care Reform

The idea of accountable care has gained worldwide attention as it attracts those in the healthcare industry who want to move toward policies that reward the quality of medical services over quantity. However, many physicians and organizations have run into issues such as institutional and cultural barriers, and a lack of a clear reform pathway.

An article in Health Affairs described a comprehensive framework that can be used to integrate the healthcare model by drawing cross-country comparisons.

“We apply the framework to examples in 3 countries to provide practical insights into how policy makers and healthcare organizations can design and implement accountable care to support new delivery models,” wrote the authors.

The framework included 7 policies in the healthcare environment that affect the impact of accountable care:

• Governance and culture, which requires sufficient leadership to shift an organization’s focus toward achieving better patient outcomes and value.
• Financial readiness, which makes it possible for an organization to bear risk and reallocate financial resources.
• Health information technology, or the infrastructure and analytics needed to support patient-centered care.
• Patient risk assessment and stratification, which makes it possible to target interventions.
• Patient engagement, or embedding the patient perspective across organizational processes.
• Quality and process improvement, or activities linked to performance measures and mechanisms that provide feedback on performance to provide better care.
• Care coordination, or integrated workflows to support continuity of care.

In addition, broader health policies such as institutional, political, and regulatory factors affect the impact of reform.

Using this framework, authors highlighted 3 different approaches to accountable care reform:

• Implementing primary care with a comprehensive person-centered focus as shown through Possible, a primary care public-private partnership in Nepal.
• Supporting person-centered care for specialized conditions as shown through Zio, a chronic disease management model in the Netherlands
• Integrating all aspects of care for each patient in a population as shown through Gesundes Kinzigtal, a population-based reform in Germany.

“These cases demonstrate how accountable care can promote the development and more effective use of care delivery innovations, such as patient self-management or telehealth, to improve outcomes and use resources more efficiently,” wrote the authors.

Possible’s negotiation of a performance-based public—private partnership with Nepal’s government showed that the shift toward accountable care requires new interactions between providers and policy makers. The cases also showed that sustaining and scaling up accountable care models require organizational innovation and policy reforms to evolve simultaneously. This was highlighted in the improvement of links between primary and specialty care in the Netherlands, and the increase of public awareness and support of accountable care through voluntary participation in Germany.

Based upon the comprehensive framework and different approaches to implement accountable care, emerging lessons for healthcare providers include: focusing on systematic change, sharing information, and using multidisciplinary teams who work together to keep care in the community.

Emerging lessons for healthcare policy makers and payers include: implementing reforms to create a supportive environment for high-value and patient-centered care, using data to support person-centered care, and developing evidence to guide and refine accountable care reforms.