NAVIGATING ACCOUNTABLE CARE AND OTHER PAYER-PROVIDER ORGANIZATIONS: AN ASSESSMENT OF EMERGING INSTITIJTIONAL STAKEHOLDERS BEHIND VALUE-BASED HEALTHCARE TRANSFORMATION

• Published in: Value in health Vol. 20; no. 5; p. A15
• Main Authors: Capuano, C, Curran, K, Yampolsky, D, Bower, D, Suponcic, S
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01-05-2017
• Subjects: Acute services; Coordination; Customers; Decision making; Executive function; Health care; Hospitals; Integrated care; Leadership; Organizational structure; Polls & surveys; Quality of care; Responsibilities; Stakeholders; Transformation; Value
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Payers are increasingly tying payment for health care to quality and value. Within this context, providers are committing to and pursuing systematic solutions to become value-based organizations. This transformation is driving changes in the leadership and organizational structures of hospitals and health systems. This research examines emerging institutional stakeholders behind value-based healthcare transformation; the scope of their responsibilities; and implications for manufacturers seeking to engage accountable care and other payer-provider organizations to drive market access. METHODS: A survey of 64 administrators and executives of integrated networks (27%) and hospital systems (73%) was conducted. Represented systems included on average 29 acute care hospitals and 83% were Accountable Care Organizations. Respondents included CSuite/ President (17%), Vice President (28%) and Director (55%) titles. The survey assessed institutional priorities related to value-based health care transformation; and leadership and organizational structure related to these priorities. RESULTS: Many domains of value-based healthcare transformation were considered, and each was widely reported to be a priority for represented institutions today. Furthermore, dedicated roles have been or will be established with focus primarily or exclusively on each: 68% of organizations have an executive function focused on Payment Transformation; 74% on Population Health Care Coordination and/or Clinical Integration; 75% on Quality; and 76% on Customer Experience. These functions operate at the enterprise (system) level in nearly half of organizations and at the affiliate level in others. CONCLUSIONS: As institutions have taken on a greater role in defining and assessing value and in operationalizing value-based decision making in healthcare, there has been a proliferation of relevant stakeholders involved in carrying out these responsibilities. Manufacturers seeking to demonstrate the value of their product within these settings must be prepared to target these emerging customers; including a tailored value proposition which considers the specific scope of their responsibilities.