Hudson Valley Health Care Convener THINC Offers Business Intelligence for Health Plans, Providers Around Bundled Payment Contracting

New white paper, "Building ACOs and Outcome-Based Contracting in the Commercial Market: Provider and Payor Perspectives," developed via frank discussions around new payment models

FISHKILL, N.Y., Oct. 24, 2011 /PRNewswire-USNewswire/ -- New value-based payment models and accountable care opportunities pose fresh challenges for health plans and health care providers needing contracting and business intelligence to move forward. A new white paper produced by a workgroup of the Taconic Health Information Network and Community provides a window into the concerns of both groups of stakeholders while offering insights into the issues they must tackle in this largely uncharted territory.

"Building ACOs and Outcome-Based Contracting in the Commercial Market: Provider and Payor Perspectives" reveals the willingness and necessity for health plans and providers to collaborate in implementing value-based payment models such as commercial accountable care organizations. Over a period of months, a THINC Workgroup held a number of facilitated discussions, bringing together health plans and providers for the express purpose of developing an understanding of one another's concerns and priorities. The work of the group sheds light on these stakeholder concerns in the Hudson Valley, and has application for health care leaders across the nation.

"The THINC Workgroup white paper sheds light on the issues providers should consider before they start the contracting conversation with commercial health plans about accountable care, and reveals health plan concerns about these trends in the marketplace," said Susan Stuard, THINC's executive director. "The discussions provided a truly collaborative environment and contributed to a framework for better understanding the expectations of all parties, as well as contributing to a clearer understanding of the path to move forward to deliver high quality, cost-effective care."

The white paper is part of THINC's ACO Insights program, an effort to provide training and technical assistance to physician practices, health plans, hospitals and other health facilities in the Hudson Valley. ACO Insights, supported by a grant from the New York State Health Foundation, also includes a daylong meeting and a series of webinars on relevant ACO topics based on a framework of ACO model components: financial and legal, leadership and operations, quality measures and improvement, and engagement.

"As accountable care takes shape via the Affordable Care Act's Medicare Shared Savings Program and CMS Innovation Center programs, physicians are keenly interested in how value-based payment models will—and should— develop in the commercial market," said Hal Teitelbaum, M.D., MBA, managing partner and CEO of Crystal Run Healthcare and THINC board member. "Physicians need to understand the financial risks, how patients will become part of their panels, what quality measures will be used and whether accurate, actionable and timely data will be made available to bolster their efforts around care management and population health. These are among the nuts and bolts of the transition from a fee-for-service model to one based on outcomes-based payments. Physicians want—and need— to be partners in the design and implementation of these innovations in health care delivery."

Payors who seek to contract with providers in this new setting also carry a set of expectations and concerns. Bringing providers and payors together to discuss the issues openly engenders not only better understanding, but also a foundation to build on common ground.

"Although both parties have concerns about who would bear the financial risk for new payment arrangements, there is considerable agreement between health plans and providers on many of the high-level principles for value-driven contracting: enhanced data-sharing, more sophisticated care management systems, and a phased approach to implementation of new models," said David Sandman, Ph.D., senior vice president of the New York State Health Foundation. "THINC's efforts to bring health care insurers and health care providers to the same table outside of contract negotiations—something that rarely happens—have been a positive step toward identifying these areas of common interest."

THINC and the Hudson Valley have been on the forefront of innovation in health care delivery, with the highest concentration of top-level medical home recognition in the nation and some 377 active providers connected through electronic health information exchange. The white paper, "Building ACOs and Outcome-Based Contracting in the Commercial Market: Provider and Payor Perspectives," is available as a free download at www.THINC.org. To view more ACO Insights materials, click here.

About the Taconic Health Information Network and Community (THINC)
THINC is dedicated to improving the quality, safety and efficiency of health care for the benefit of the people of the Hudson Valley region of New York. The primary purpose of THINC is to advance the use of health IT through the sponsorship of a secure health information exchange network, the adoption and use of interoperable EHRs and the implementation of population health improvement activities. These activities include public health surveillance and reporting, pay for performance, patient-centered medical home practice transformation, care coordination activities, public reporting, and other quality improvement initiatives. For more information, go to www.THINC.org. THINC is part of the Hudson Valley Initiative, an effort to revolutionize health care delivery through a shared vision to improve the quality, safety and efficiency of health care in the community. To learn more, go to http://www.hudsonvalleyinitiative.com.

SOURCE THINC