Health System Transformation

Better for patients; Better for health care team members—Research conducted by the American Heart Association found that care provided through ACO models is better for patients and better for health care team members. The AHA conducted 27 in-depth, semi-structured interviews across the country with medically complex patients and/or their family caregivers and members of the health care team who receive or provide care through an ACO model.

The findings support efforts by AHA and other patient and consumer advocacy organizations, policy makers and others to advocate for changes to the health care delivery and payment system that improve the experience of care, outcomes and efficiency for all stakeholders.

• Patients and Family Caregivers (PDF)
• Health Care Team Members (PDF)
• Examples of Going Above and Beyond (PDF)

In October 2021, the Centers for Medicare and Medicaid Services (CMS) Innovation Center released the Innovation Center Strategy Refresh, a new vision intended to guide the next phase of health system transformation. In this vision, the CMS Innovation Center outlined an aggressive new strategy seeking to achieve equitable outcomes through high-quality, affordable, person-centered care, with 5 strategic objectives (show figure attached):

1. Driving accountable care: Increase the number of beneficiaries in a care relationship with accountability for quality and total cost of care.
2. Advancing health equity: Embed health equity in every aspect of CMS Innovation Center models and increase focus on underserved populations.
3. Supporting care innovations: Leverage a range of supports that enable integrated, person-centered care, such as actionable, practice-specific data, technology, dissemination of best practices, peer-to-peer learning collaboratives and payment flexibilities.
4. Improving access by addressing affordability: Pursue strategies to address health care prices and affordability and reduce unnecessary or duplicative care.
5. Partnering to achieve system transformation: Align priorities and policies across CMS and aggressively engage payers, purchasers, states and beneficiaries to improve quality, achieve equitable outcomes and reduce health care costs.

As part of the strategy refresh, the CMS Innovation Center sought input from stakeholders. To provide input on the strategy refresh, the American Heart Association together with the Duke Margolis Health Policy Center convened a group of experts from different backgrounds and perspectives to identify best practices for addressing cardiovascular health and provide suggestions for incorporating cardiovascular disease prevention and management best practices into the design and implementation of value-based payment models. The expert panel met on 3 occasions between November 2021 and January 2022 and developed recommendations aligned with each of the 5 CMS Innovation Center strategic objectives.

The American Heart Association supports a health care system that is person-centered, focuses on improving individual and population level experience and health outcomes, promotes health equity,  and rewards our health care workforce for how well they do versus the number of billable services regardless of outcomes. Below are AHA publications addressing the need for health care delivery and payment reform and to move away from traditional fee for service. Value-based care (or person-first care) offers the opportunity to improve our health care system. As value-based care grows and evolves it is essential that organizations like AHA are engaged to ensure the changes are truly person-centered and ensure that everyone has access to high-value, whole person-centered care that is affordable.

• CMS Value-Based Care Spotlight
• Health Care Learning and Action Network, AHA is a member of the HCPLAN Accountable Care Action Collaborative
• Health Care Transformation Task Force: AHA is a member of HCTTF
  • HCTTF Consumer Resources
    • Reimagining Beneficiary Engagement in Value-Based Care Models
    • Consumer Engagement and Education in Health Care Transformation
• Accountable for Health: AHA participates on the A4H Voices for Accountable Care
• National Association of ACOs (NAACOS)
• Orientation video for patient representatives on the ACO Boards
• Families USA
• A Pro-Consumer Policy Agenda to Achieve Meaningful health System Transformation
• Health Care Value
• Community Catalyst
• Reimagining the Health System
• Primary Care Collaborative