Population health efforts require accountability realignment, researchers say

Value-based payment systems like Medicare’s Merit-based Incentive Payment System (MIPS) hold providers accountable for population health measures driven by factors beyond their control. This has resulted in a misalignment in accountability, according to a commentary in the American Journal of Accountable Care.

The authors state that although providers aspire to create well-coordinated, population health-oriented communities of care, payment models like MIPS often do not consider social determinants of health in terms of their impact and the type of care coordination needed to administer nonmedical services. Providers, regardless of the setting they work in, are held accountable for improving outcomes that require social services and public health programs. In addition, payment reform efforts have been too imprecise to drive significant improvements in care delivery.

The authors of the study use treatment for major depressive disorder as an example as to how shared accountability could work when individual providers understand their role in population health initiatives. According to the authors, providers should focus quality measures on services clinicians actually provide like depression screenings, rather than on antidepressant medication management outcomes that occur later in the treatment process and in coordination with other services. Access to such mental health and social or community services may be affected by social determinants like poverty and lack of transportation.

Additionally, efforts to collaborate with community partners and social service providers must occur, and payment models should reward providers for these efforts Shared accountability and community buy-in at a local level have the potential to accelerate population health care delivery, according to the authors.