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Sunday, December 16 , 2018, 2:54 am | Fair 45º


Sansum Clinic CEO Joins White House for Kickoff of Health Care Payment Learning and Action Network

On Wednesday, Dr. Kurt Ransohoff, CEO and chief medical officer of Sansum Clinic in Santa Barbara, joined President Obama and Health and Human Services Secretary Sylvia Burwell at the White House for a kickoff meeting of the Health Care Payment Learning and Action Network.

The network aims to bring public- and private-sector actors together to build on the Affordable Care Act's efforts to move health care toward a system that provides the best care for patients and pays providers based on the quality rather than the quantity of care they give patients. More than 2,800 payers, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the network — approximately 100 of those organizations represented the network at the kickoff event at the White House.

“We commend Secretary Burwell’s efforts to build a health-care system that delivers better care more efficiently,” Dr. Ransohoff said. “Through our work with CAPG and now the Health Care Payment Learning and Action Network, we are pleased to be contributing to solutions that will improve accountability, patient outcomes and affordability on a broad scale.”

The Affordable Care Act established an ambitious new framework to move the health-care system away from rewarding health providers for the quantity of care they provide and toward rewarding quality. These new models have been put to work in Medicare and have contributed to 50,000 fewer patient deaths in hospitals due to avoidable harms, such as infections or medication errors, and 150,000 fewer preventable hospital readmissions since 2010, when the Affordable Care Act became law.

Secretary Burwell earlier this year announced the ambitious goal of tying 30 percent of payments to quality and value through alternative payment models by 2016 and 50 percent by 2018 under new approaches to paying for health care created by the Affordable Care Act. The network will accelerate this transformation of the nation’s health care delivery system to one that achieves better care, smarter spending and healthier people, by supporting the adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare.

“It is in our common interest to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people,” said Secretary Burwell. “When government and business work together we can all benefit. Patients can get the right care at the right time, doctors can achieve the best ideals of their profession, and health care can be more affordable for individuals and companies.”

The Affordable Care Act put in place financial incentives for hospitals and other providers to promote quality while making health care affordable. HHS has already seen promising results on transforming the health care delivery system, including:

» More than 400 Medicare Accountable Care Organizations (ACOs) participating in the Shared Savings Program and the Pioneer ACO Model have generated a combined $417 million in savings for Medicare;

» Initiatives like the Partnership for Patients, ACOs, Quality Improvement Organizations and others have generated a 17 percent decline in the rate of hospital-acquired conditions, $12 billion in health care cost savings and saved 50,000 lives between 2010 and 2013;

» Medicare hospital readmissions decreased by nearly eight percent – translating into 150,000 fewer readmissions between January 2012 and December 2013;

» Through the work of the Partnership for Patients and the Strong Start for Mothers and Newborns initiative, early elective deliveries decreased 64.5 percent nationwide between 2010 and 2013, thus improving birth outcomes and meaning fewer at-risk newborns; and

» Doctors’ offices and other providers participating in ACO programs and other Innovation Center initiatives have offered expanded office hours and 24 hour call lines to improve access and support care coordination.

Among the organizations that have set their own goals for rewarding value are the following:

» American Cancer Society. The American Cancer Society and its advocacy affiliate, the American Cancer Society Cancer Action Network, are committed to working with their partners in the coming years to encourage the development of care delivery models that incorporate a patient-centered approach to care and educate people with cancer and their families about models that improve the overall quality of care.

» American College of Physicians. The American College of Physicians (ACP), representing 141,000 internal medicine physicians (internists), subspecialists and medical students, will educate its physicians about, and promote broad adoption of, the alternative payment model, including the Patient-Centered Medical Home (PCMH), the PCMH neighborhood/specialty practice model and ACOs. ACP is committed to continuing to develop numerous tools and resources to help physicians make the transition to these alternative payment and delivery system models and through its High Value Care initiative and its Center for Patient Partnership in Healthcare, will promote ways for patients and clinicians to work together as partners to achieve the highest quality, patient-centered health care.

» Caesars. Earlier this year, Caesars Entertainment launched a bundled payment demonstration project for non-emergent surgical procedures, like hip and knee replacements, with dramatically reduced cost sharing. If the demonstration project is successful, Caesars Entertainment will look to expand this program in its other markets, impacting up to 29,000 covered employees and 23,000 dependents. (Bundled payment models generally group each individual service a patient receives during an episode of care into one payment, aligning financial and quality performance accountability across providers.)

» Cigna. Cigna agrees to the goals set by HHS, including 90 percent of payments in value-based arrangements and 50 percent of payments in alternative payment models by 2018. Cigna will particularly focus on ensuring that physicians providing care to its most vulnerable and at risk customers have an incentive and assistance to provide high quality, value based care. (Value-based arrangements generally tie financial incentives to quality or value.)

» State of Delaware. Delaware has set a goal of having 80 percent of the State’s population receive care through value-based payment and service delivery models within five years.

» Dignity Health. Dignity Health has committed to move 50 percent of its payments to accountable care by 2018, and 75 percent by 2020.

» Rite Aid. Rite Aid will educate its associates about the use of alternative network options that promote improved health outcomes and lower health care costs. It is working with its benefit administration partners to have more than 50 percent of the company and associates medical spend supported by health care access through alternative models by 2018. Rite Aid will also develop unique and innovative programs that aim to achieve many of the same goals as value-based health care, like improving the health of its patients while avoiding costly hospitalizations. For example, the Rite Aid Health Alliance is an integrated delivery model in which Rite Aid pharmacists and health coaches partner with medical providers to help patients, with one or more chronic diseases, better manage their conditions.

— Jill Fonte is the marketing director for Sansum Clinic.


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