New Models to Achieve the Triple Aim

Focusing on value-based payment structures has helped Mount Auburn Hospital design care delivery to meet patient and community needs. Located in Cambridge, Mass., Mount Auburn is the 220-bed regional teaching hospital for Harvard Medical School, serving the Boston and Cambridge metropolitan area. Revenue from risk-based contracts is more than 30 percent of the hospital's total patient revenue, and 25 percent of commercial hospital payments are from pay-for-performance programs. The hospital has signed an alternative quality contract with a local health payer, and the current agreement focuses on quality, cost of membership and streamlined administration. Since signing the contract, patient experience and quality scores have increased to 93 percent. In addition, total medical expenses have stabilized to a single-digit increase or decrease each year. Though Mount Auburn Hospital has experience with risk contracting and pay-for-performance, hospital leaders describe it as a “learning curve” and “continual journey.” Keys for transitioning from volume to value include: getting leadership support; ensuring the hospital and physicians work together with the same goals; successfully collaborating with payers, which requires transparency in sharing data; having a critical mass of patients before assuming risk; and developing new skill sets and resources for financial modeling and case management.

For more information, contact Kathryn Burke, vice president of contracting and business development, at kburke1@mah.harvard.edu.

Two AHA committees, the 2015 Committee on Research and 2015 Committee on Performance Improvement, released “Care and Payment Models to Achieve the Triple Aim.” This joint report outlines seven principles for redesigning care delivery systems and describes innovative payment models.