Industry report identifies key principles providers face in today’s APM environment

The core message from a recent report released by the American Hospital Association (AHA) Center for Health Innovation indicates that healthcare payors will continue to shift greater risk to providers as new models emerge and health systems will need to find ways to adapt and succeed within these new parameters. 

As payors began to move into alternative payment models (APMs) a decade ago, also commonly referred to as value-based payment models, AHA says eight common principles of evolving care models have emerged, prompting many health systems to evolve along the way by modifying their care models to meet the needs of patients while maintaining alignment with their organizational cultures.

The AHA said its findings are based on information and insights culled from hospital and health system leader interviews, surveys, and industry experts, as well as healthcare reports and research articles.

While the specifics differ, AHA’s report said the expert panel identified the following common underlying principles that healthcare facilities should consider:

·   Organize care delivery around the needs of patients across the care continuum (e.g., inpatient, ambulatory, post-acute) through ownership or partnerships with affiliated providers, allowing health systems to better manage patients post-discharge and avoid costly readmissions.

·    Significantly broaden the health care provider’s scope, from a narrow focus on individual patients’ disease states and episodes of care to a broad focus on the health of populations, including addressing care needs across the continuum and considering health-related

·    Social factors — like housing and food insecurity — that have traditionally been far outside the healthcare sphere.

·    Redefine the role of the physician from an autonomous actor to leader of an integrated care team of advanced practice providers, nurses and others focused on creatively engaging patients and closing gaps in care.

·    Introduce complex new workflows and technologies — including the use of real-time data to drive clinical decision-making and complementing the traditional medical visit model with proactive care management and telehealth programs.

·    Deliver evidence-based clinical care and effectively use care management to support high-needs patients, including addressing the social determinants of health. This approach addresses patient needs upstream and reduces unnecessary and expensive inpatient hospitalizations and emergency department visits.

·    Adopt IT infrastructure and analytic capabilities to track patient quality and cost outcomes, identify high-risk/high-cost patients and coordinate patient referrals, enabling care management teams to direct at-risk patients to the appropriate care setting and reduce unnecessary inpatient utilization.

·    Evolve financial management systems to manage risk-based contracts, including tracking performance on contracts with downside risk and putting risk-mitigation strategies in place to ensure that APMs can sustainably finance the new care delivery model.

·    Align governance and management processes to support alternative payment and care delivery — including processes to build provider buy-in, develop clinical alignment across the network and build new workforce capabilities — to enable care delivery transformation.