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Major providers, insurers unite to shift more business to quality-of-care model

Jan 28, 2015

Major providers, insurers unite to shift more business to quality-of-care model

(Story updated at 12:30 p.m. ET.)

Several of the nation's largest health systems and insurers are joining together in a new task force with the goal of shifting 75% of their business to contracts with incentives for quality and lower-cost healthcare. 

The Health Care Transformation Task Force includes some of the largest U.S. health systems, including Ascension, St. Louis, and Trinity Health, Livionia, Mich., and insurance giants Aetna and Health Care Services Corp. Employer Caesars Entertainment and the Pacific Business Group on Health also are involved. 

The task force members said they would reach their target by January 2020. 

Also in the task force are regional giants Partners HealthCare, Boston, and Advocate Health Care, Chicago

"We want to align the way we provide care and pay for care in order to achieve the triple aim outcomes," Dr. Tim Ferris, Partners' senior vice president for population health, said in a statement, referring to three widely cited goals of health-policy makers and industry initiatives: improved health, lower cost and a better patient experience. 

The group will seek to develop policy proposals and private-sector initiatives. Initial efforts will focus on accountable care, bundled payments and management of the cost and quality of care for high-cost patients, including those with multiple chronic conditions and near the end of their lives, according to the task force website. 

Task force members will seek to enter contracts that “successfully incentivize and hold providers accountable for the total cost, patient experience and quality of care for a population of patients, either across an entire population over the course of a year or during a defined episode that spans multiple sites of care.”

The group's announcement comes days after federal health officials unveiled a plan to shift half of their spending not devoted to managed care—roughly $362 billion last year—into accountable carebundled payments and other contracts with the potential for rewards or penalties based on quality performance and better cost control. 

The announcement Monday by HHS Secretary Sylvia Mathews Burwell won praise for its commitment to an overhaul of Medicare's fee-for-service program. That program covers 70% of Medicare enrollees and pays hospitals and doctors for each test, visit and procedure performed. The industry and policymakers fault such a payment arrangement for creating incentives to treat patients without any consideration of whether medical care is needed. 

But the federal push to expand its use of new incentives for quality and efficiency also raised questions about whether such efforts will succeed. The evidence for accountable care and bundled payments is limited, experts said, and more work is needed to develop useful quality measures and financial incentives. 

Burwell also announced a Health Care Payment Learning & Action Network of private- and public-sector healthcare players to share information about payment initiatives.

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