Heather Zacker Discusses Barriers to Implementation of Increased Risk Arrangements

The idea of risk sharing within value-based care is a wonderful concept, but it has not yet changed behavior and outcomes to the extent one would hope, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center. A potential reason is the variation in metrics and incentives used within different systems.

Transcript (slightly modified)

How have increased risk arrangements changed the way healthcare providers work together?

The concept of value-based care and of sharing risk is a wonderful, beautiful concept, right. So in theory, everyone understands what his or her role is, and has the incentives to provide just the right amount of care and education. In actuality, again, the systems and infrastructure are really not set up in so many health systems, and certainly globally or in the US, to facilitate that and to be conducive to that.

So when you look at the data, CMS reported on the 2014 results of the ACOs [accountable care organizations] and the shared savings plans, and there were improvements in quality measures. Great. I think it was something like 27 or 28 of 32 or 33 quality measures improved over the course of the year. That’s a good thing. But the costs were really not lowered in the way that one might have anticipated. And the quality improvement scores, I think they averaged like 3 or 4% improvement. So something’s not quite right yet.

When I think about it, logically, if you’re treating a number of patients and you’re a health system or a clinic, and you don’t know which patient walks into your office from Blue Cross and which one’s from Medicare and which one’s from Aetna and which one’s from a different commercial insurer. So there’s so many different metrics that are perhaps slightly different, and different incentives, and so without a closed system, it gets very, very hard.

In answer to your question, how do increased risk arrangements change behavior, how have they sort of played out, I would say we have not seen them play out optimally yet.