Health Plans and Providers Partnering to Advance Accountable Care

For Immediate Release
September 8, 2011

Price Atkinson
(202) 778-8494

New AHIP Article in Health Affairs Examines Private-Sector Accountable Care Models

AHIP Announces Oct. 18 Summit on Shared Accountability and Payment Reform

Washington, D.C. – New health care delivery and payment models in the private sector are being shaped by active collaboration between health insurance plans and providers, according to a new study by America’s Health Insurance Plans (AHIP) that appears in the September edition of Health Affairs. The article found that not all providers are equally prepared to enter into accountable care arrangements and that flexibility and the technical assistance and support of health plans will be key to the success of these arrangements.

The article, “Early Lessons from Accountable Care Models in the Private Sector: Partnerships Between Health Plans and Providers,” written by Aparna Higgins, Vice President of Private Market Innovations, and other colleagues at AHIP, examines accountable care models developed by eight health plans. Together these plans represent two-thirds of the thirty identified accountable care models that are currently being tracked by AHIP.

The Centers for Medicare and Medicaid Services (CMS) recently released the Proposed Rule for the Medicare Shared Savings Program and announced additional care initiatives through the Center for Medicare and Medicaid Innovation. The new AHIP study identifies several important lessons that can inform how the rule is developed.

“While the policy discussion in Washington is focused on the need for delivery system reform, health plans and their provider partners are already making it happen across the country. America’s health insurance plans are implementing payment reform models that are working in the marketplace and showing tangible results,” said Karen Ignagni, President and CEO of AHIP.

Alternative and Delivery Payment Models - Private Sector Initiatives

Flexibility is needed to meet the varying needs and capabilities of providers  

The AHIP study found that providers have different levels of experience, capability, and readiness to enter into accountable care arrangements. Rather than take a one-size-fits-all approach, health plans adjusted their arrangements to meet the abilities and needs of their provider partners and their respective patient populations.

“In contrast to the Shared Savings Program, which specifies levels of shared savings or losses for accountable care organizations, health plans tailored levels of risk and reward to match their providers’ capabilities and readiness,” the authors noted.

Health plans identified a number of criteria to evaluate a providers’ readiness to enter into accountable care arrangements, including: the level of clinical integration, presence of a strong, forward-thinking leadership, willingness to enter into a long-term relationship, the ability to initiative and implement change, the existence of strong health IT infrastructure, sufficient patient size, the willingness to participate in performance-based reimbursement models, and ability to accept some form of financial risk.

Importantly, the article notes that all of the models studied involved changes to payment methods and represented a movement away from fee-for-service in varying degrees.

Technical assistance is key to the success of accountable care organizations 

According to the study, “Technical assistance to providers has been identified as one of the key requirements to their success in accountable care arrangements.” Health plans are able to assist and support providers in a number of important ways, including:

  • Assisting with population health management by providing detailed and up-to-date claims data as well as analytical reports that highlight progress and identify gaps in care;
  • Connect providers with health plans’ disease and case management services by embedding nurse case managers in provider practices, providing clinical decision-support tools, such as condition-specific care guidelines, and hosting monthly clinical sessions to facilitate greater collaboration;
  • Provide access to health information exchange systems that allow for two-way flow of information for better case management and clinical decision support; and
  • Helping to manage financial risk through predictive modeling and the provision of stop-loss coverage or reinsurance. 

The study found, as noted above, that the amount and type of assistance provided by health plans depends on the specific needs and capabilities of providers. Moreover, the article states that existing data elements required in the Medicare Shared Savings Program are “inadequate for effective population management” and urges CMS to “provide different types of data and analytic reports to participating providers” similar to what occurs in existing private sector arrangements.

Preliminary results show higher quality and lower costs  

The study highlights preliminary data from health plans showing the effectiveness of these accountable care arrangements at improving the quality of patient care and lowering health care costs. The health plans studied “reported approximately 10 percent improvements in quality, a 15 percent decrease in readmissions and total patient days in a hospital, as well as annual savings of $336 per patient.” The authors also note that “formal evaluation studies will, however, be needed to ascertain the effectiveness of these models.”

AHIP Summit on Shared Accountability and Payment Reform on October 18 

To further advance the discussion of delivery system reform, AHIP is hosting a Summit on Shared Accountability and Payment Reform on October 18, 2011 at the The Ronald Reagan Building and International Trade Center in Washington, D.C. The summit will showcase the most innovative models that regional and national health plans have implemented to achieve the three-part aim of better care, healthy people/healthy communities, and affordable care. A variety of approaches such as ACO-contracting, patient-centered medical homes and bundled payment will be showcased. The Summit will highlight key program features, successes, and lessons learned that can help enhance understanding of alternative pathways to building a sustainable, high-quality health care system.

Click here to read the full article in Health Affairs and here to read the abstract.

To learn more about AHIP’s Summit on Shared Accountability and Payment Reform click here. For complimentary press registration, contact Price Atkinson at 202-778-8494 or

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