A new issue brief released this week by the Commonwealth Fund highlights several diverse approaches to shared-savings arrangements, including the populations and services covered, the assignment of providers, the use of risk adjustment, and the way savings are calculated and distributed. The brief also identifies issues payers and providers must resolve going forward, such as determining whether savings were achieved, equipping providers with necessary tools and technical advice, agreeing upon standard performance measures, and refining the model over time.
Shared-savings arrangements have "attracted great interest, in part fueled by Affordable Care Act provisions that create accountable care organizations and by the movement among medical home pilots to make payment methodologies more performance-based," say the authors. "The current flurry of activity is sparking creativity and the opportunity to try different approaches."
For this brief, the authors conducted 32 telephone interviews with payer and provider organizations and state agency agencies that indicated they were involved in 27 independent past, current, and planned shared-savings payment arrangements.