High Performance Accountable Care: What Do We Need to Do? Stuart Guterman Vice President, Payment and System Reform Executive Director, Commission on a High Performance Health System The Commonwealth Fund Alliance for Health Reform Briefing on Accountable Care Organizations Washington, DC May 13, 2011

The Need for Coordinated, Accountable Care Access problems Waste and inefficiency Poor coordination of care—especially if multiple doctors are involved Public Support for Policies to Improve Coordination People want more accessible, coordinated, well-informed care People think doctors working in teams or groups improves care Majority of Americans say the health care system needs fundamental change or complete rebuilding

Moving Toward a High Performance Health System Essential elements of a high performance health system: Affordable coverage for all Aligned incentives to promote quality and efficiency Increased accountability Improved coordination of care Effective leadership in the policy and health care communities There’s a strong relationship between the way we pay for health care, the way health care is organized, and the way it is delivered The creation of ACOs as a new type of provider in the Affordable Care Act recognizes the importance of coordinated, accountable care in achieving the goals of a high performing health system: Better health Better care Lower cost This new initiative is consistent with all five elements above

Recommendations from the Commonwealth Fund Commission on a High Performance Health System Overall goal: to achieve a high performance health system that is organized to attain better health, better care, and lower costs Strong Primary Care Foundation Accountability for Quality of Care, Patient Care Experiences, Population Outcomes, and Total Costs Informed and Engaged Patients Commitment to Serving the Community Criteria for Entry and Continued Participation That Emphasize Accountability and Performance Multi-Payer Alignment to Provide Appropriate and Consistent Incentives Payment That Reinforces and Rewards High Performance Innovative Payment Methods and Organizational Models Balanced Physician Compensation Incentives Timely Monitoring, Data Feedback, and Technical Support for Improvement

Important Considerations There is a real need for coordinated, accountable care that is patient-centered, effective, and efficient There is an important relationship between payment methods, the organization of health care delivery, and health system performance The current payment system encourages fragmented, uncoordinated care and does not reward value Changing the way health care is paid for, organized, and delivered is essential to achieve the Triple Aim of better health, better care, and lower costs—and there’s a lot to be gained from achieving these goals The Affordable Care Act, in provisions like the one that creates ACOs, provides a set of policies that can help move the health system toward these goals Success requires bold action, leadership, and collaboration on the part of Medicare, other public programs, and private insurers, as well as hospitals, physicians, and other providers, and patients For ACOs to be successful, they will need a clear idea of what is expected of them, a strong connection between their performance and how and what they are paid, and data and technical support in making the changes necessary to improve the way health care is delivered and reduce cost growth