January 2023Employers should expect more from the U.S. health care system

Health care costs in the United States continue to rise, for both employers and employees, with no corresponding improvement in outcomes. One way to better align health care costs with patient outcomes is by increasing our investment in accountable care.

When providers are paid mostly based on volume of services, they're not compensated for preventing illness or helping patients proactively manage their health. Historically, fee-for-service payment models have undervalued high-touch primary care and prevention. Accountable care enables high-quality, patient-centered care by changing how we pay for care.

Traditional Care Accountable Care
Patient Experience Patient Experience
  • Reactive: You reach out for an appointment when you have a medical concern or need an annual appointment
  • Inaccessible: Often hard to get timely appointments; hard to get answers to questions outside of appointments
  • Incomplete: Hard to get all of your needs addressed in one place
  • Fragmented: You have to do the follow-up and coordinate your care across multiple providers
  • Proactive: Care team reaches out to assess health needs and offer preventive care
  • Accessible: Care available when and how you need it (e.g., virtual or in-person, same-day)
  • Comprehensive: Address-ing physical and mental health needs in one place
  • Simple and coordinated: Single point of contact coor-dinating care across special-ists and settings
Provider Payment Incentives Provider Payment Incentives
  • Volume-driven: Fee-for-service payments aligned to more visits and procedures
  • Outcome-driven: Value-based payments aligned to improved quality and equity at lower cost
Patient Experience

Traditional Care

  • Reactive: You reach out for an appointment when you have a medical concern or need an annual appointment
  • Inaccessible: Often hard to get timely appointments; hard to get answers to questions outside of appointments
  • Incomplete: Hard to get all of your needs addressed in one place
  • Fragmented: You have to do the follow-up and coordinate your care across multiple providers

Accountable Care

  • Proactive: Care team reaches out to assess health needs and offer preventive care
  • Accessible: Care available when and how you need it (e.g., virtual or in-person, same-day)
  • Comprehensive: Address-ing physical and mental health needs in one place
  • Simple and coordinated: Single point of contact coor-dinating care across special-ists and settings
Provider Payment Incentives

Traditional Care

  • Volume-driven: Fee-for-service payments aligned to more visits and procedures

Accountable Care

  • Outcome-driven: Value-based payments aligned to improved quality and equity at lower cost

Accountable care models have been successfully deployed in Medicare and Medicaid, and generated valuable lessons:

  • Accountable care is feasible and impactful
  • There's no one-size-fits-all approach to accountability
  • Success requires aligning capacity, incentives and tools to create a high-value experience for patients

Resources

January, 2022

Report: Employers should expect more from the U.S. health care system

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