Panel takes step toward new model for health care delivery
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Health Policy Commision executive director David Seltz said new standards could lead to lower costs.
Groups that participated in the drafting process for new state criteria regulating accountable care organizations are eyeing the standards as a small but significant step in transforming the health care system in Massachusetts.
At an April 27 Health Policy Commission meeting, members voted to approve criteria laying out requirements for provider organizations to be certified as accountable care organizations. Known as ACOs, such organizations feature networks of doctors who collaboratively manage a patient's care.
"The Health Policy Commission's ACO Certification Program is built on our overall vision for accountable care: a health care system that efficiently delivers on the 'triple aim' of better care for individuals, better health for populations, and lower cost through continual improvement," HPC executive director David Seltz said in a statement. "The HPC Board's vote to finalize the assessment criteria was an important part of the process and now we look forward to continuing the work to build and implement the program."
Before last week's meeting, accessible health care advocacy group Health Care for All called for the commission to adopt "bold" standards that would "push the envelope," said Brian Rosman, the group's government affairs and policy director.
With the Massachusetts Public Health Association, Health Care for All wrote a letter to the commission, urging its members "to use the ACO guidelines to signal to all providers and payers that our health care system must move beyond its fragmented and narrow approaches to patients and consumers."
"This is always a work in progress," Rosman told the News Service. "We know there's a lot of broad agreement on the goals, and from the HPC's point of view, this is a voluntary program and it's understandable, I think, to us they would sort of take baby steps into the beginning."
Currently, Rosman said, patients "experience a fragmented system," with different components focused only on distinct issues rather than viewing patients as a whole.
"We think ACOs represent an opportunity -- if we do it correctly in Massachusetts -- to really transform our health care system," Rosman said. He said an ideal system would bring patients into a partnership with their ACO and have providers not just looking to treat patients who are already sick but to work with them to broadly maintain health.
A payment restructuring effort is underway at MassHealth that would move the state Medicaid program toward an ACO model instead of its current fee-for-service method.
The state plans for a full rollout of ACOs in October of 2017.
Newly formed ACOs will be able to receive "provisional certification" if they meet certain criteria and demonstrate plans to meet other criteria. Provisional certification will allow the ACOs to participate in the MassHealth contracting and payment model. The HPC plans grant full certification sometime within the first performance year, according to materials presented at the meeting.
"The final certification standards will be especially important as MassHealth moves forward with redesign efforts in the Medicaid program," Massachusetts Association of Health Plans president and CEO Lora Pellegrini wrote in a letter to the commission. "The redesign will encourage care to be delivered by ACOs and as such, we must ensure that there are appropriate safeguards in place to protect those who are most vulnerable."
Pellegrini described the adopted criteria as a "great middle ground," saying her organization was satisfied after components featured in an earlier draft and then removed were added back into a final version.
"We want those standards to be meaningful and not just taking the existing system and calling it something new. I think that's what we achieved," she told the News Service. "It's baby steps."
MAHP, which represents 17 member health plans, supported language reinserted into the final criteria that calls for evidence-based practice among medical professionals and quality reporting measures.
"It was important we got these initial standards correct, but it will be an ongoing process as we have more expertise around what accountable care means," Pellegrini said.
Under the newly approved criteria, providers seeking to be certified as ACOs would need to prove they have a "patient-centered, accountable governance structure," participate in quality-based risk contracts, offer population health management programs and coordinate with behavioral health, hospital, specialist and long-term care services, among other requirements.
The organizations would also need to commit to "consumer price transparency," and to adopting and integrating advanced health information technology.
Before launching the ACO program, the commission will next look to build a platform through which providers can apply for certification, draft an application manual and hold provider trainings.
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