Barely a week goes by these days in which I fail to get a press release touting a new and unique contractual arrangement between a health system and a payer. Last week, there were a couple, including one from Trinity Health-Michigan and the state's Blues plan. The two agreed to a "landmark contract" that changes the way the health system is paid. Similar to so many other pacts taking shape across the nation, the BCBS-Trinity deal is a migration toward accountable care and value-based reimbursement.
The markets are clearly speaking, but are they speaking clearly?
What seems to be missing in most of the announcements is a consumer education piece. What is your average consumer supposed to make of these new arrangements? How will they be impacted, if at all?
According to a recent Kaiser Family Foundation survey, nearly 60 percent of U.S. adults have no idea how the ACA will impact their lives. That's for a law that's been in the 24-hour news cycle for several years now. Imagine how much consumers know about a value-based contract your organization just struck with a faceless insurance carrier. First off, they have to understand which type of contract you struck. A recent report from CSC details the different types of arrangements taking shape across the industry. Phrases like bundled payment, shared savings, shared risk and capitation may be commonplace in your boardroom, but I can't say that I've heard them uttered when standing in line at the local deli. The nomenclature can be mind numbing, let alone the intricacies of how these contracts will change care delivery.
Most hospitals aren't communicating these contractual changes with consumers just yet because they're seen as new payment issues, not necessarily something that's altering the patient interface, David Muhlestein, senior analyst at Leavitt Partners, told me last week. However, he pointed out, hospitals that view ACO-type of arrangements as a market differentiator or as a way to change patient behavior are being more proactive.
"One thing that's prominent about accountable care is how it is supposed to affect the patient experience," Muhlestein said. "That is something you can lead with. No patient will complain about better care and better care coordination. That is an alley hospitals can go down."
Muhlestein said that Leavitt Partners' most recent data show 470 ACOs nationwide. Of those, 202 are physician driven, hospitals lead 201, insurers 40, and the rest by a wide variety of stakeholders.
A complication in studying these new enterprises, though, is the varying definitions being used, Muhlestein said. In fact, Leavitt Partners is in the process of pulling together a taxonomy that will help the industry and others speak the same language. It should be published within the next couple of months.
While a taxonomy of terms isn't the silver bullet to better patient understanding of — and engagement in — accountable care, perhaps it can spur greater dialogue between hospitals and their communities.