Top Things to Know: American Heart Association’s Call to Action for Payment and Delivery System Reform

1. The healthcare system is undergoing a transition from paying for volume to paying for value.
2. The Centers for Medicare and Medicaid Services (CMS) has announced achievement of its previously stated goal to tie 30% of Medicare fee-for-service (FFS) payments to quality or value through alternative payment models by 2016 and is moving towards its 50% goal by 2018.
3. CMS has also announced that it will connect 85% of all Medicare FFS payments to quality or value by 2018 and 90% by 2019.
4. To be both thoughtful and proactive, the Association convened an “Expert Panel on Payment and Delivery System Reform” in 2015 with clinical and economic experts from leading institutions. The panel was tasked with assessing the current environment of payment and delivery system reforms and determining the optimal role for the American Heart Association in moving forward on behalf of patients.
5. The paper offers support and direction for further involvement in payment and delivery system reforms by the Association.
6. In doing so, it (1) provides baseline review and definition of the present models and some of the early results of these delivery models, including outcomes; (2) initiates a conversation within the AHA/ASA on the impact of payment and delivery system reform, and how the Association should engage in the interest of patients; (3) issues a “Call to Action” to our organization and cardiovascular and stroke health professionals across the country to become educated about these models so to as to understand their impact on patient care; and (4) asks the government and other funding agencies, including the Association, to begin supporting and prioritizing meaningful research endeavors to further evaluate these models.
7. The Patient Centered Primary Care Collaborative, along with the Milbank Foundation conducted a review of evidence of 28 PCMH studies in peer-reviewed academic, state government, and industry reports. They reported improvements in utilization, reduction in cost of care, improvements in quality, access, and patient satisfaction. Of those outcomes improvements, cardiovascular care impacts of note included improvements in LDL screenings and reductions in readings, as well as improved control of blood pressure.15
8. In an extensive report which included 32,334 fee-for-service beneficiaries in various Accountable Care Organizations (ACOs), Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, such as access to care and care coordination, improved significantly when compared to non-ACO care. The improvements were modest and greater for patients with complex conditions as well as the highest risk patients.
9. Much of the analysis to date has focused on quality measurement and achievement of cost savings, and therefore, important opportunity remains to better characterize the models’ long-term clinical outcomes. Given the heterogeneity across these models, research focusing on and identifying particular aspects that make them successful would be a significant contribution to the evidence base.
10. There are numerous and substantial opportunities for cardiovascular and neurological specialists to lead clinical care transformation and support research, evaluation, measure development and quality improvement projects that will refine and inform these models

Bufalino VJ, Berkowitz SA, Gardner TJ, Piña IL, Konig M; on behalf of the AHA Expert Panel on Payment and Delivery System Reform. American HeartAssociation’s call to action for payment and delivery system reform [published online ahead of print July 10, 2017]. Circulation. doi: 10.1161/CIR.0000000000000516.