One of the biggest challenges facing the U.S. health system is the rising cost of healthcare. The traditional fee-for-service insurance model exacerbates this issue by generally limiting its approach to “sick care” and paying for it based on the volume of the services that patients receive as urgent needs arise, without regard to prevention, outcomes or care coordination. By embracing “accountable care”—focusing coverage and payment on a comprehensive view of quality, value and efficiency of services—the healthcare system can help address cost pressures and move toward accountability for the outcomes and costs of care.
Accountable care is not a one-size-fits-all approach; it incorporates such entities as accountable care organizations (ACOs), patient-centered medical homes (PCMH) and integrated care delivery systems. By aligning incentives, focusing on population health and giving providers valuable, tailored support in moving along the pathway to full accountability, health plans can help transform the system and eliminate inefficiencies. No matter where such an approach fits on the accountable care continuum, it is focused on achieving the triple aim of higher quality, lower costs and improved outcomes.
Value-based payment under accountable care arrangements is not a new concept for the health system. Medicare Advantage and other private plans for decades have been proving their success in paying for value. Such arrangements redirect the focus toward preventive care, chronic disease management and an enhanced patient experience. Providers who are in accountable care arrangements do a better job of keeping their patients healthy and out of the hospital, and they receive higher quality ratings for the care they provide.
The move away from paying for sick care and toward paying for accountable care is one that the entire system is starting to undergo, and with good reason. The success stories shown by those who already have made the transition demonstrate a proof of concept. When accountable care becomes the preferred approach throughout the health system, everybody can benefit.
January 1, 2015
Learn more about Humana’s accountable care efforts here.