5 Best Practices Shared for Value-Based Care by NAACOS, AMA, and AHIP

 Erika Regulsky RCM
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Advancing Value-Based Care through Improved Data Sharing Practices

In recent years, value-based care has emerged as a critical model for transforming the US healthcare system. It focuses on improving patient outcomes and reducing costs by rewarding healthcare providers based on the quality of care they deliver rather than the volume of services they provide. To make value-based care successful, stakeholders must address several challenges, including data-sharing practices. The American Medical Association (AMA), the National Association of ACOs (NAACOS), and America’s Health Insurance Plans (AHIP) recognize the importance of data-sharing and have jointly released “The Future of Sustainable Value-Based Care and Payment: Voluntary Best Practices to Advance Data Sharing.” This article provides valuable insights for payers, physicians, and other healthcare stakeholders to implement effective value-based care arrangements.

1. Creating an Interoperable Data Ecosystem

One of the primary challenges in value-based care is the lack of interoperability among different data systems used by healthcare entities. To address this, stakeholders can leverage data exchange networks to facilitate data sharing across the care continuum. Using standardized data sets and elements and adopting application programming interfaces (APIs) for Electronic Health Record (EHR) data access can foster interoperability.

AMA value based care, AHIP value based care, and NAACOS value based care should advocate for contract terms that promote adherence to exchange standards and the use of a core data set. Real-world testing of these standards is vital to ensure their clinical and financial relevance to contracting parties.

2. Sharing Comprehensive Data

To gain a holistic view of patient populations, value-based care participants require comprehensive data that integrates clinical and demographic information. This integration can be achieved by including individual and practice-level provider numbers on claims and reports, as well as integrating pharmacy data.

AHIP, AMA, and NAACOS value based care should focus on providing aggregate population-level spending and treatment data to improve comprehensive data. By regularly sharing raw claims data with providers and maintaining updated billing information, stakeholders can enhance the accuracy and timeliness of aggregated performance feedback.

3. Improving Data Collection to Advance Health Equity

The pursuit of health equity is a core objective of value-based care. Collecting data from community-based organizations that address health-related social needs can help identify disparities beyond the clinical setting. Stakeholders should engage community networks and support health and non-health data-sharing networks to enhance care coordination.

AHIP value based care, AMA value based care, and NAACOS value based care should emphasize including standards focused on health-related social needs in contracts to drive adoption. Training, end-user support, and transparent communication with patients about data use are vital for successful data collection.

4. Sharing Actionable Data

To drive proactive care interventions, stakeholders must present actionable, consistent, and reliable data in a readily accessible and usable format. Limiting data at the point of care to actionable information enhances clinical decision-making. Real-time information on patient admission and discharge can be shared through existing data-sharing networks.

Payers should transition from proprietary portals to standardized data measures and automate data sharing to accelerate performance feedback. Creating dashboards displaying cost, quality, and utilization data with contextual information can empower healthcare practices to monitor performance and identify areas for improvement.


5. Making Data Calculations Readily & Easily Available

Access to complete data and the methodologies behind it is crucial for designing effective interventions. Regular sharing of performance data and providing a feedback loop for updates or corrections is essential. Payers involved in value-based care arrangements should share established or estimated benchmarks ahead of the performance period to foster transparency.

AHIP, AMA, and NAACOS value based care can contribute to a thriving value-based care landscape by regularly sharing information on the reliability of estimates used in calculations.

In conclusion, data-sharing practices play a vital role in advancing value-based care in the US healthcare system. The collaboration between AHIP, AMA, and NAACOS to release “The Future of Sustainable Value-Based Care and Payment: Voluntary Best Practices to Advance Data Sharing” is a significant step towards realizing the full potential of value-based care arrangements. By creating interoperable data ecosystems, sharing comprehensive data, advancing health equity through improved data collection, and providing actionable data, the US healthcare system can better align incentives, enhance patient outcomes, and foster a culture of value-based care.

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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