Exploring lessons learned from value-based care payment arrangements

Permanente physician leaders joined representatives from the American Medical Association (AMA), National Association of Accountable Care Organizations (NAACOS), and AHIP at last week’s Virtual Value-Based Payment Summit to discuss the growing need for value-based payment arrangements. Specifically, they talked about a value-based care playbook they created for health care organizations that look to align payment with performance on quality, cost, and patient and physician experience.

Stephen Parodi, MD, executive vice president of The Permanente Medical Group and The Permanente Federation, represented the American Medical Association in the conversation. He noted the timeliness of the playbook on how health care is paid for particularly around Medicare and Medicaid.

“I think what this does is it shows alignment amongst AMA, NAACOS, and AHIP to say, ‘We do think there’s a way to do this. We do think there’s a pathway, a playbook,’” said Dr. Parodi. “I hope there are others out there that are making these decisions and that they take a look at it.”

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The playbook was designed for organizations at different stages of using value-based payment arrangements and brings in perspectives of health plans, medical providers, ACOs, and others. 

“What this playbook does is it allows for everyone to actually have a bit of a level playing field for how to think about approaching these arrangements,” said Dr. Parodi. 

The playbook is a helpful checklist for entering into value-based payment agreements. It outlines 7 key domains that need to be addressed upfront, such as benchmarking efforts that combine actuarial projections with the goal of positive clinical outcomes, plus agreement on levels of risk that make sense to all parties before unforeseen cost challenges arise. 

Beyond a payment strategy, true value-based care is about medical excellence 

Efforts like the playbook collaboration emphasize what Kaiser Permanente has demonstrated throughout its history: Value-based care is more than just a payment strategy but an approach that delivers high-quality, integrated, affordable, patient-centered care. 

“What we’re interested in doing is seeing how we can move closer towards more models that incent value, as opposed to volume of care, and a transition from wholly fee-for-service-based arrangements,” said Dr. Parodi about a priority goal for advocacy of Permanente Medical Groups. 

During a panel on how payers and providers can collaborate on high-quality oncology care that incorporates the patient experience, Tatjana Kolevska, MD, chair, Kaiser Permanente Northern California Oncology and Hematology, shared how integrating patient perspectives, the best evidence-based treatments, affordability, and care team support creates the best patient outcomes. 

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A positive example of integrated care raised by Dr. Kolevska is the Kaiser Permanente virtual cancer expert review program, which uses a technology platform that allows oncologists to request expert specialist consultations on cases. Analytics showed the program influenced care decisions for 93% of the treating oncologists using the service.

Dr. Kolvelska added that because value-based care payment arrangements incentivize better patient outcomes, one key benefit to oncology is better end-to-end cancer care support, including prevention, diagnosis, treatment, and survivorship programs. 

For Dr. Kolevska, the first step for organizations starting their value-based journey is to define value from the clinical delivery team perspective and from the health plan perspective and then move to address components like utilization of scans, hospitalizations, and cancer drugs. 

“To me, the definition of value and understanding of both parties, and of course patients, is very important at the beginning,” said Dr. Kolevska.  

Register here to watch archived panels from the Summit.