AHIP, AMA, NAACOS Playbook Recommends Best Practices for Sustainable Value-Based Care

AHIP, formerly called America's Health Insurance Plans, the American Medical Association (AMA), and the National Association of ACOs (NAACOS) released a playbook detailing voluntary best practices for value-based care (VBC) payment arrangements, the organizations announced in a press release.¹ The playbook is part of their collaborative efforts to increase VBC adoption in the private sector and improve health care quality, equity, and affordability.

The voluntary best practices in the playbook aim to streamline, align, and scale VBC arrangements and follows a prior playbook² on advancing data sharing in VBC. With participation in VBC payment arrangements growing in recent years, the new playbook pulls from lessons learned in the implementation of VBC.³ The voluntary best practices compiled by AHIP, AMA, and NAACOS as part of the Future of Value Initiative aim to increase awareness around strategies that work well in VBC and reduce barriers that may discourage participation in VBC arrangements, such as administrative burden.

“In the last decade, value-based care has grown from almost nothing to undeniably significant aspect of our health system. Today, for example, accountable care organizations are 20% of Medicare alone,” Clif Gaus, ScD, president and CEO of NAACOS, said in a statement.¹ “This iteration of the playbook synthesizes what we’ve learned over the last decade plus, so that payers, physicians, hospitals, and ACOs can implement payment and delivery models that improve outcomes and lowers costs.”

An advisory workgroup of AHIP, AMA, and NAACOS members convened to produce the playbook, a process which included literature review, an environmental scan, and subject matter expert interviews. As the group was formed, the organizations ensured diversity in terms of VBC experiences, practice sizes, and practice independence. Individualized needs for rural communities and underserved populations were also a focus.

Value in health care | Image credit: leowolfert - stock.adobe.com

The playbook includes a range of recommendations and insights on VBC arrangements, with input from physician experiences, VBC entities, and health plans. A total of 7 domains were included:

1. Payment attribution
2. Benchmarking
3. Risk adjustment
4. Quality performance impact on payment
5. Levels of financial risk
6. Payment timing and accuracy
7. Incentivizing for value-based care practice participant performance

Each domain is addressed in a chapter including a definition, what the goals for that domain are in relation to sustainable VBC payment arrangements, a summary table of best practices, key challenges, and details around the voluntary best practices that should be considered. The playbook also includes examples to illustrate the strategies and how they can help achieve the goals of VBC arrangements.

“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. This playbook reflects input from physicians in an array of practice settings on their lessons learned for patient attribution and financial risk and benchmarking. It will be a valuable resource for both those with experience in value-based care and those who are just getting started,” AMA president Jesse M. Ehrenfeld, MD, MPH, said.

With the first and second installations of playbooks to help improve VBC, the Future of Value Initiative aims to continue highlighting best practices that may mitigate costs, improve patient experiences, and improve population health.

“Overcoming recent challenges to the expansion of value-based care arrangements requires focused and sustained collaboration across the system,” Mike Tuffin, president and CEO at AHIP, said. “This partnership among key stakeholders brings to the forefront voluntary best practices for aligned models that can streamline operations and build resiliency to expand access to high-quality, equitable and affordable value-based care.”


References

1. AHIP, the American Medical Association, and the National Association of ACOs release playbook with recommendations toward a sustainable future for value-based care payment. News release. AHIP. April 10, 2024. Accessed April 10, 2024. https://www.ahip.org/news/press-releases/ahip-the-american-medical-association-and-the-national-association-of-acos-release-playbook-with-recommendations-toward-a-sustainable-future-for-value-based-care-payment

2. Joszt L. AMA, AHIP, NAACOS release playbook on data sharing best practices for value-based care. The American Journal of Managed Care^® website. July 26, 2023. Accessed Apil 11, 2024. https://www.ajmc.com/view/ama-ahip-naacos-release-playbook-on-data-sharing-best-practices-for-value-based-care

3. AHIP, AMA, NAACOS. A Playbook of Voluntary Best Practices for VBC Payment Arrangements. AHIP, AMA, NAACOS; 2024. Accessed April 10, 2024. https://www.aurrerahealth.com/wp-content/uploads/2024/03/Playbook-Voluntary-Best-Practices-for-VBC-Payment-Arrangements.pdf