Collaborative Care Delivery Models Can Inform Development of Value-Based Payment Models

Value-based payment models reflecting the importance of team-based care in the management of patients with chronic cardiovascular conditions can help improve care delivery and health and better support cardiovascular specialists in the transition to value-based care, according to a paper published Nov. 29 in the Journal of the American College of Cardiology.

Paul N. Casale, MD, MPH, FACC, et al., utilized feedback from the December 2020 ACC Value-Based Care in Cardiology Forum, which convened clinician, payer, purchaser, and policymaker thought leaders to discuss value-based payment models for chronic cardiovascular diseases, using newly diagnosed atrial fibrillation (AFib) as the clinical focus. Additional authors include Rachel Roiland, RN, PhD, and Robert Saunders, PhD, who worked with the ACC on the 2020 Forum and currently lead payment and delivery reform research and initiatives at the Duke-Margolis Center for Health Policy in Washington, DC.

The authors present a conceptual framework for a collaborative care model that provides an integrated delivery approach to AFib to improve value, promote guideline adherence, and reduce disparities. In addition, the authors identify how payment models can support the delivery approach and discuss issues to facilitate implementation.

The collaborative care model for AFib management identifies primary care-cardiology as the accountable team that guides treatment and organizes care for patients, with a clinical model offering shared accountability among providers “with mutually aligned care processes grounded in evidence-based practice and collaborative decision-making to manage patient risk and severity of symptoms.” An interdisciplinary model requires coordination and commitment among team members in primary care, cardiology and electrophysiology. In addition, a value-based care model may include a clinical operations team comprising advanced practice clinicians, pharmacists, nurses and social workers, each with defined roles and responsibilities, workflows and order templates to allow standardization of care across multiple providers within and across settings.

The authors also outline payment model considerations for practices that are part of an integrated delivery network, as well as independent practices. They note that payers will need to consider flexibility in payment approaches based on practice structure and location and explore ways to fund participants and facilitate timely intervention for patients. 

According to the authors, additional work is needed to “improve existing” value-based payment models to “better align” with cardiovascular care. The authors note that while AFib was identified for the forum discussion, similar principles could be applied for other conditions. The authors encourage stakeholders to “take action to implement and participate in [value-based purchasing] models that support the patient-centered, team-based approach to managing chronic [cardiovascular] conditions while achieving high-value care and positive outcomes for patients and the health care system as whole.”

The 2021 ACC Value-Based Care in Cardiology Forum will be held on Thursday, Dec. 2, at 9:30 a.m. ET. Follow @Cardiology on Twitter for updates.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Decision Making, Electrophysiology, Patient-Centered Care, Reference Standards, Social Responsibility, Evidence-Based Practice, Financial Management, Primary Health Care, Health Policy, Cardiology, Delivery of Health Care, Pharmacists, Guideline Adherence, Cardiovascular Diseases, Value-Based Purchasing, Atrial Fibrillation, ACC Advocacy

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