GSK U.S. Public Policy Position Paper
Value Based Delivery: Accountable Care
Organizations & Patient Centered Medical Homes
The Issue
Many factors have led to a fractured healthcare system. Value Based Delivery models, such as the Patient
Centered Medical Home (PCMH), Accountable Care Organization (ACO), and various payment
arrangements aim to contain rising healthcare costs and restructure financial incentives across healthcare
stakeholders. Tenets of Value Based Deliver are improving the delivery of high-quality, coordinated care,
decrease the cost of care and to align incentives across stakeholders. This concept is manifesting through
new models for healthcare delivery and payment.

The patient-centered medical home (PCMH) is a primary care-based delivery model that provides
continuous, comprehensive, and coordinated care in the context of family and community, encouraging
whole-person care by offering participating providers a per-member, per-month (PMPM) care
i
coordination fee.

The accountable care organization (ACO) is a group of doctors, hospitals, and other health care
providers who come together voluntarily to be accountable to deliver coordinated high-quality care to
patients. Though ACOs can vary considerably in their structure and processes, they all include
elements of collaboration to meet patient needs, to maintain or enhance quality of care, and to lower
costs. When an ACO succeeds in both delivering high-quality care and spending health care dollars
ii
more wisely, it will share in the savings.

Payment models, such as pay for performance (P4P), bundled payment, and global payment, offer
payment to providers who meet certain cost and quality standards during a specific care episode or
time frame. Additive bonus payments may also be offered to high-performers. Such payment models
can be provided as an add-on to shared savings and per member per month (PMPM) fees in ACOs and
PCMHs.
GSK Position
The development and implementation of new payment and delivery models is a crucial step in identifying
innovative ways to deliver high-quality, efficient care to patients. GSK continues to support the development
of Value Based Delivery models, where there is accountability for both the delivery of quality and efficiency.
In these emerging models, GSK supports the use of performance measures to encourage the advancement
of high-quality care through adherence to clinical guidelines, improvements to care coordination and care
transitions, and a focus on patient decision making and patient experience of care.
.
Key Points
Gaps in Value Based Delivery:
 Existing measures do not adequately assess outcomes and efficiency
 Uptake of e-measures is critical to success, to ensure that performance measures are consistently
defined, implemented, and compatible across EHRs and other clinical IT systems
A Publication of GSK Public Policy and Government Relations
(continued from front)
Gaps in Value Based Delivery:
 Data sharing across stakeholders is often limited
 Risk adjustment methodologies need a clear process for incorporating new information
Challenges:
 Limitations in data sources cause delays in evaluation and limit measures that can be used
 Appropriate measures that may better assess performance in these models have yet to be developed
and/or integrated into current models
iii
 Stakeholders have different goals and, therefore, different definitions of success
Public Policy Opportunities






Encourage the adoption of evidence-based measures endorsed through a transparent multistakeholder process (e.g. National Quality Forum) within Value Based Delivery models
Support outcomes based measures that improve patient health
Promote measuring quality at the healthcare organization level using measures that address
prevention, care coordination, care transitions, comprehensive medication management, patient
outcomes, and efficiency
Encourage regular updates to reflect the latest medical knowledge, clinical guidelines, and innovation
within value based delivery models
Support the adoption of e-measures, which provide standardized electronic information and technology
to enhance delivery and payment reform with the understanding that improvements in quality and
efficiency are mutually dependent on parallel adoption
Include quality and accountability measures that maximize medication adherence, self-management,
and clinical health improvements within evaluation of ACOs, PCMHs, health homes, community care
teams, and other collaborative care models
Updated 10-28-2013
i
American Academy of Family Physicians, et al. (2007). Joint Principles of the Patient-Centered Medical Home.
http://www.medicalhomeinfo.org/joint%20Statement.pdf. Accessed February 2011.
ii
Centers for Medicare and Medicaid Services. Center for Medicare and Medicaid Innovation. http://innovation.cms.gov/initiatives/ACO/
iii
“Building the Evidence Base for the Medical Home: What Sample and Sample Size Do Studies Need?” AHRQ. October 2011.
http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483/pcmh_evidence___evaluation_v2.
[i]
Centers for Medicare and Medicaid Services. Center for Medicare and Medicaid Innovation.
http://innovation.cms.gov/initiatives/ACO/
A Publication of GSK Public Policy and Government Relations