Welcome to this inaugural issue of the LAN eNewsletter. We are moving quickly to make progress on our ambitious agenda, with the end goal of generating a tipping point in payment reform. Such broad transformation will only succeed with the engagement of stakeholders like yourself. This biweekly newsletter, as well as other communications, will keep you up to date on what is happening and where we need your help. We will also be launching a collaboration site so we can more fully engage your expertise as we work together strategically to accelerate change.
The Guiding Committee held its first meeting by phone on May 27. Co-Chairs Mark McClellan and Mark Smith reminded members that the committee’s role is not to set or make policy recommendations but rather to provide executive leadership to align participants and achieve the LAN’s goals.
Committee members came to the meeting having considered what priorities could enable the LAN to provide practical assistance to the field in the near term. Additionally, Guiding Committee members discussed key barriers to payment reform the LAN can help reduce. The resulting initial priorities were reported in the June 10 webinar (see page 2) and include:
• Defining terms and concepts in a way that non-experts can understand (e.g., definition of value, types of alternative payment models [APMs])
• Seeking alignment in APM technical components (e.g., patient-reported outcomes and experience measures, attribution approaches, clinically relevant data sharing, and implementation approaches)
• Making the business case for small and medium practice providers • Ensuring that incentives to move from fee-for-service to APMs don’t penalize early adopters while providing support to those just beginning their transition
• The importance of sharing best practices, early results and learning to inform the transition process across all stakeholder groups
Members agreed on the need, across all the LAN’s work, to remain cognizant of the impact that movement toward APMs will have on low income and vulnerable populations.
The first LAN webinar on June 10 attracted nearly 600 participants. The featured presentation on the Massachusetts Alternative Quality Contract (AQC) generated many questions on how the model was implemented. Dana Gelb Safran, Senior Vice President, Performance Measurement & Improvement at Blue Cross Blue Shield Massachusetts (BCBS-MA), reported that BCBS-MA was determined to cut spending by half and focus on improving quality of care and outcomes for their members. They designed the AQC payment model for interested providers, and 95% of their providers are contracted under the AQC. The model is based on a full global budget for populations— covering the full continuum of care, from pre-natal care to end-of-life care, with quality incentives for providers based on nationally accepted measures. The AQC was able to achieve savings of 10% by the end of 2014 across all BCBS provider groups as compared to a control group. Quality measures related to adults with chronic care needs, pediatric care, and adult health outcomes demonstrated significant improvement over national health outcomes for these populations.
Mount Auburn Cambridge Independent Practice Association (IPA), with 520 physicians, entered the AQC to save money on risk contracts and improve quality of care. Barbara Spivak, IPA’s president, described IPA’s Pod structure as a group of peer-selected physicians who meet monthly to examine the services happening outside of the hospital and encourage providers to bring the care into the hospital under contract. IPA pharmacists, care managers, and disease managers attend these meetings and are also assigned to each clinical practice. Leader physicians who come to the Pod meetings are paid above their rate for 90 minutes of seeing patients and must attend 8 of 11 annual meetings in order to receive their surplus. Physicians subscribe to this model because it provides them with data and supports their efforts to render quality care. Spivak noted that supportive leadership, managing the data, educating first with rewards before penalties, and developing win-win relationships and contracts between PCPs, specialists, and Mount Auburn Hospital are critical keys to success.
Safran and Spivak graciously responded to participant questions after the webinar, and these Questions and Answers will be posted soon. We know many people are eager to review the webinar slides. We are working to make the slides accessible and provide them on the new LAN website that is currently under construction, to be launched this month.
The Guiding Committee met on June 22 to refine the initial priorities put forth in May (see page 1) and begin laying out strategies for aligning the private and public sectors to move U.S. health care payment to at least 30% alternative payment models (APMs) by 2016 and 50% by 2018.
Because the most detailed work will be done in issue-specific Work Groups, the Committee devoted a significant portion of the day-long meeting to firming up plans for the first Work Group. It also discussed three other potential areas for Work Groups to consider in greater detail at an upcoming meeting: population health payment models, specialty care payment models, and high cost/high need patients.
The Committee also agreed on the necessity of robust mechanisms for engaging the wider LAN community to inform the work as it unfolds and foster learning and sharing. A new public website will be launched soon, and regular webinars are being planned. The next in-person LAN meeting will be in the Washington, D.C., area this fall. Details will be announced soon. Regional meetings to bring conversations closer to participants are also being explored. A full summary of the June 22 meeting will be posted in the near term.
Alternative Payment Model (APM) Definitions and Progress Tracking Work Group
Thanks to everyone who applied or referred someone for this Work Group—over 150 highly qualified names were submitted. The CAMH Team is in the process of selecting 10–12 candidates with diverse perspectives and qualifications to serve on the Work Group, which will be announced by mid-July.
The Group’s charge is to recommend a set of APM terms and concepts that will serve as a foundation for the LAN’s work going forward. These terms must be easily understood but also specific enough to be operationally meaningful. In addition, the group will propose an approach for measuring APM adoption across the U.S. health care system, which includes clarity on what should be measured as well as a set of categories that enable meaningful reporting.
A listserv will be set up for participants with special interest in this topic as an affiliated community of experts who can provide input and feedback as the work evolves. Stay tuned for more information.
The Health Care Transformation Task Force brings together providers, payers, purchasers, and patient representatives to align public and private sector efforts to transform the U.S. health care system. Dr. Richard Gilfillan, Task Force Chair, spoke with a member of the CAMH team on June 24.
[CAMH]: What are the goals of the Health Care Transformation Task Force and what is your strategy for achieving them?
Gilfillan: Our goal is to simplify the path for delivery system transformation for our members and, we hope, more broadly for the country at large, so we can accelerate progress toward a health care system that achieves the Triple Aim. We aspire to leverage the collective experience of our members and share those learnings and recommendations with the entire health care community.
We believe that the central issue is to get payment methodologies in place that support organizations going down this pathway. We have multiple strategies. First, we’d like to set an example and demonstrate what is possible if we make a firm commitment to our aim of having 75% of our respective businesses operating under value-based payment arrangements by 2020. We’ll try to be leaders for the industry. Second, we want to give input to public policy makers to encourage the development of payment models that are optimally supportive of organizations making that transition. Third, we want to develop common approaches to alternative payment models in the private sector so that the private and public sectors are better aligned. Fourth, we’d like to identify best practices for payment and delivery models that we can make available to members and others. The cornerstone of our strategy is that as a multi-sector organization that includes payers, providers, employers, and consumer representatives, we can develop solutions that are workable for all and in the best interest of the system as a whole.
[CAMH]: As you may know, the LAN currently has a two-year time frame. Where do you think the greatest opportunities for near-term results lie?
Gilfillan: It would be useful for the LAN to look at the current environment we’re operating in and ask, given these circumstances, what strategy would best facilitate meeting the Secretary’s goals. Developing a recommended strategy and a set of principles to guide decision making regarding the details of payment policy would be very valuable. Then we can start laying out key issues and opportunities that need to be addressed to encourage people to go down the path.
There is more than enough information about how to deliver higher value care. The really difficult issues are the payment models to promote that and the operational issues between payers, providers, employers, and consumers that get in the way. I think developing shared recommendations around payment issues, like benchmarking and rebasing as well as operational issues like provision of data and waivers, could make a real difference. I think the LAN could also conduct a review of alternative payment models that are in operation today and identify the approaches taken to these key issues. An inventory like this could inform all of our work through sharing the wisdom gained by organizations across the industry over many years. I believe the system is poised to move rapidly toward a new model. However, to get more organizations aggressively moving, we need to create reasonable opportunities for success early on. CMS, and all sectors, will ultimately benefit from the momentum built on early wins.
[CAMH]: What do you think are the most important activities that the LAN and the Task Force could collaborate on to deliver concrete results in that time frame?
Gilfillan: We would like to help on those key tasks of developing a strategy and priority issues to be addressed. We have already done some work in these areas, including defining “what counts” toward our goal of 75% of our businesses in valuebased payment by 2020, as well as helping to identify standardized approaches to issues like simplifying quality measures, beneficiary attestation, and benchmarking that could be used across public and private sectors. Aligning these efforts will simplify and accelerate the work of transformation for everyone. We look forward to sharing all the work we have done to date and want to be very engaged and supportive of the LAN’s efforts.
To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume. The Health Care Payment Learning and Action Network (LAN) was established as a collaborative network of public and private stakeholders, including health plans, providers, patients, employers, consumers, states, federal agencies, and other partners within the health care community.