Accountability Drives Performance in Value-Based Payment Models

 Value-based payment models are designed to encourage—and reward—better care assessed, in part, through performance on quality measures. But performance is unlikely to improve if accountability for care is not adequately defined. For accountability to be effective it must be specific, agreed upon and associated with sufficient incentives for entities to agree to be accountable We can think of at least five core aspects of accountability that drive quality improvement: 

1. Secure buy-in. Attribution models (e.g., prospective, retrospective, mixed) have different strengths and weaknesses. The key is to define and agree on an attribution approach so the responsible entity (clinician, practice, group, specialty) is clear about the population for which it is accountable. 

2. Deliver performance data to the point of care. Performance criteria used to calculate incentives (or penalties) are typically reported only periodically, but an organization needs regular access to performance data to guide care. This is also key to driving adoption of new evidence into practice.  

3. Support robust data exchange. Payers and health systems need to provide the most complete data possible to ensure that accountable entities have the best information on which to drive quality improvement for individual people and populations. 

4. Use existing clinical workflows. Health care delivery is complex and workflows are not always efficient, but adding data collection requirements simply to generate data for measures creates barriers to alignment and adoption. Data should be based on information generated in the normal course of taking care of people. Clinical teams cannot be expected or required to check a box or ask additional questions during a patient
encounter if the activity is not directly related to delivery of care. 

5. Focus on measures that matter. The best way to undermine an accountability model is to use measures that are considered irrelevant by clinical teams and patients. Measures need to be appropriate for the population, feasible to collect and based on data already generated in the delivery of care. The best measures will generate timely and actionable guidance for clinicians and their teams to help develop care plans with their patients, identify the best treatment options and address gaps in care. 

How is your organization addressing the core aspects of accountability? 

Do you agree with the premise that better definitions of accountability are a prerequisite to better value-based payment models? 

Which of these five aspects of accountability are the most challenging?  

What other issues should we consider?  

Share your thoughts in the community forum.