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Global Accountable Care: Translating our Gesundes Kinzigtal Models of Accountable Care for High-Need, High-Cost Populations in the United States

Driven by aging populations, rising expectations for high quality care and the increasing burden of chronic diseases, countries around the world are implementing accountable care principles to address these emerging health care challenges. In the US since 2010 Accountable Care Organizations (ACOs), integrated unions of healthcare providers which contract with an insurer to provide better health, better care and higher cost efficiency for a defined population by enhanced cooperation, whereby at least a part of the population-based payment is linked to a set of measures for quality and efficiency1. ACOs have seen a rapid proliferation since their introduction in the 2010 Affordable Care Act (ACA). In just six years they rose from zero to over 800 (total public and private ACOs), covering about 28.3 Million people2. This growth has been especially pushed by a clear policy shift of CMS (state insurance program for all people over 65 in the US) from volume to value based payment for providers. The interim results on quality and efficiency of ACOs are so far mixed, but also performance measurement methods highly disputed.

To facilitate learnings for the US ACO movement from international best practices on Accountable Care, the Duke-Margolis Center for Health Policy, headed by Mark McClellan one of the main originators of the Accountable Care movement in the US, recently conducted a study on international Accountable care best practices. The study was sponsored by the Commonwealth Fund, a private independent foundation based in New York City, promoting a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. Mark McClellan et al. have systematically applied an accountable care framework to describe and analyze value-based policy, organizational competencies and political environments in a variety of case examples from Germany, the Netherlands, Nepal, Singapore and the United Kingdom. Our Gesundes Kinzigtal model has been selected as best practice model from Germany. Based on these examples, Mark McClellan et al have developed policy implications that payers and policymakers in the US could adapt to better support providers who are transforming the way care is delivered. The research findings from the five international case studies (including Gesundes Kinzigtal) and lessons learned from the international examples are shared here. The link also provides access to a video record of a discussion of the study results from the Translating International Models of Care for High-Need, High-Cost Populations in the United States symposium from January 30, 2017 in Washington, DC. On May 17, 2017.

As main lessons that US policy makers may learn for the further development of ACOs in the US from our Gesundes Kinzigtal have been highlighted:

  • foster population health and avoid gaming through patient or provider selection focus on contracts for the population of a whole region (not only those who are mainly served by participating physicians
  • support scientific evaluation and share claims data with ACO/providers to allow them to monitor the provision of care of the whole population and implement a data-driven management approach
  • offer long-term shared savings contracts that support investment in the health of the population (achieving an ROI within this time). Develop a “culture of health and mutual improvement”
  • Recognize incremental pace of change and use shared savings with upfront investment or advance payments to build a financial foundation for value-based payments

On May 17, 2017 Dr Alexander Pimperl also shared his insights from the work on this study and his experiences from his Harkness Fellowship in the US concerning ACOs to a German audience at a BMC event.

1 McClellan, M., A. N. McKethan, J. L. Lewis, J. Roski, and E. S. Fisher. 2010. “A National Strategy to Put Accountable Care into Practice.” Health Affairs, 29(5): 982–990, doi:10.1377/hlthaff.2010.0194.
Shortell, S. M., L. P. Casalino, and E. Fisher. 2010. “Implementing Accountable Care Organizations,” Advancing National Health Reform, Berkeley: Berkeley Center on Health, Economic & Familiy Security, Berkeley Law, University of California.

2 http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/