July 21, 2015 – eNewsletter


· LAN Website Launches

· Webinar: LAN Learnings in July

· Save the Dates – Upcoming Webinars

· Organizational Commitments

· Work Group Corner

· Stakeholder Event – LAN Summit

· Participant Spotlight – Susan Sheridan

· New Resources

· LAN by the Numbers

Be the first to visit the new LAN website! You’ll find information on LAN activities, including Guiding Committee meetings, work group announcements and, webinar invitations and archives. We’ll be adding more features and updates in the near term, so be sure to bookmark it.

Join us for “LAN Learnings in July,” a LAN webinar today, July 21 from 12:00-1:30 PM ET to hear updates from LAN Guiding Committee co-chair Mark Smith on plans for the first LAN work group and outcomes from the June 22 Guiding Committee meeting. This webinar will feature presentations by two health plans and a consumer perspective on the use of innovative payment approaches for cancer care.

Dr Lee Dr. Lee N. Newcomer, Senior Vice President, Oncology, Genetics and Women’s Health will present UnitedHealthcare’s pilot that explores a head and neck cancer care payment model focused on quality patient care and outcomes.

Dr.Malin_Jennifer Jennifer Malin, Staff Vice President, Clinical Strategy, will present Anthem’s pathway-oriented model, which provides certain treatment options and provider payment arrangements. What are the outcomes of these programs? And what is the impact on consumers?

ShelleyWe’ll hear a reaction from Shelley Fuld Nasso, Chief Executive Officer of the National Coalition for Cancer Survivorship.


Register for this second webinar in the LAN monthly series.

Ask your questions in advance! If you already have questions on this month’s webinar presentations, send them to PaymentNetwork@MITRE.org. You may also submit your questions to the presenters during the webinar.

August 17

12 – 1:30 PM ET

September 9

3 – 4:30 PM ET

November 4

1 – 2:30 PM ET

December 2

2 – 3:30 PM ET

Stay tuned for topics and registration links

A growing number of organizations have set their own goals in an effort to match or exceed the goals set forth by the Secretary of Health and Human Services for increased alternative payment model adoption throughout the U.S. health care system. Goals vary by type of organization and may include percent of business, services, members, covered lives, or medical spend in alternative payment models. Goals may also be commitments to raising awareness or educating employees and members, or (for states) enacting legislation. The following partners have set organization-specific goals to encourage the adoption of health care payment models that improve quality and decrease cost across the U.S. health system.

AARP Alliance of Community Health Plans American Cancer Society American College of Cardiology American College of Physicians AmeriHealth Caritas Anthem Ascension Atrius Health Avamere Health Services Blue Shield of California Bluestone Physician Services Buying Value Caesars Cigna
Coastal Carolina Health Care Dignity Health Evolent Health Families USA Greenville Health Systems HCSC Humana HealthInsight Kaiser Permanente Montefiore National Partnership for Women & Families Optum Partners HealthCare PatientPing Pioneer Health Alliance Premier
Primary Care Partners Prospect Medical Holdings Rite Aid SSM Health Care State of Colorado State of Delaware State of Maine State of Massachusetts State of New York State of Rhode Island State of Washington Trinity Health UnitedHealthcare Walgreens Walmart Westchester Health

Sam Nussbaum, Executive Vice President, Clinical Health Policy and Chief Medical Officer at Anthem, Inc., will be heading the Health Care Payment Learning and Action Network (LAN) Alternative Payment Model (APM) Definitions and Progress Tracking Work Group. Dr. Nussbaum commented on the upcoming launch of the Work Group.

[CAMH]: How would you describe the task of the work group?

Definitions are an enabler or scaffolding for guiding reform across the nation. We must recommend definitions that can work everywhere— in small and large and urban and rural health settings, and for health systems and providers at different levels of maturity. We’ll also take a scorecard approach, rather than just basic numbers, for recommending how to track success. We need to measure whether the whole field is moving forward.

[CAMH]: Why have you committed to chair this group?

The LAN is making a vital contribution to the future of health care in our nation. Just as we need wise investment in education, energy, and job creation to be successful as a country, we also need a healthy and productive
Organizational population. The LAN publicprivate partnership is one of the most compelling ways of harnessing smart and sophisticated initiatives for accelerating reform. I look forward to facilitating the energy and deep passion of its members to make a difference improving health outcomes and the efficiency of care delivery.

[CAMH]: What is the first thing you see the work group tackling to begin its work?

The work group will build on the strong knowledge base of what has been done already. Our task will be to assess what has been achieved, identify those models that have led to better outcomes for various conditions, and then seek input from the best and brightest to refine our recommendations and ensure scalability.

[CAMH]: How will you engage the LAN for input on the group’s work?

We will seek the input of an affiliated community of LAN participants who have particular interest in this definitions work and who can serve as an expanded cadre of experts to provide feedback as the work evolves.  There will also be an opportunity for input at the LAN stakeholder meeting to be held this fall.

LAN Summit logo

After the highly successful LAN launch event on March 25, we are looking forward to hosting another in-person meeting to accelerate our progress toward achieving widespread adoption of alternative payment models (APMs). We are now planning a fall Summit in the Washington, D.C., metro area. This meeting will provide an opportunity to exchange ideas on new payment models with other participants and hear from success stories. There will be updates from LAN work groups as well as general and breakout sessions. Stay tuned for more information, including registration details. We hope you will join us. Please help us shape this event to meet your needs. Let us know which topics would provide the most value to you and what you would hope to take away from the Summit to help accelerate payment reform.

downloadSusan Sheridan, MBA, MIM, DHL, Director of Patient Engagement for the Patient-Centered Outcomes Research Institute (PCORI), spoke with a member of the CAMH team on July 7.



[CAMH]: Tell us about your story and how you became a patient advocate?

Sheridan: I became an advocate 20 years ago after two of my family members experienced significant adverse outcomes in the health care system. I have witnessed the value and power of bringing patients with “lived experience” into the dialogue about improving our system’s ability to provide outcomes that matter most to patients. In the early 2000s, I began working with a group of mothers who partnered with multiple stakeholders to improve the care of newborn babies with jaundice. Ultimately, they succeeded in raising the standard of jaundice care in the United States.
[CAMH]: Why should patients be involved in conversations around payment mechanisms and value?

Sheridan: Payment methods can have a profound influence on the care patients receive and the outcomes they experience. It is essential that “value of care” be measured according to what is important to patients when determining the amount of payment to providers. For example, care that gives patients functional independence and less pain might be rated as high in value and lead to higher payments to providers, giving them incentives to provide more of that kind of care. In the development of new payment models, the patient community must help define which outcomes patients value most. Then “how I end up,” as one patient expressed it, becomes increasingly more important to providers.

[CAMH]: What is an example of applying patient-centered research to payment reform efforts?

Sheridan: Patients now have the opportunity to engage as partners in Patient-Centered Outcomes Research (PCOR), which helps determine the clinical effectiveness of treatment options that matter to patients, such as quality of life (functionality, quality of sleep, level of pain, level of independence, mood, ability to be at home, etc.). These patientcentered outcomes can be quite different from the traditional clinical outcomes determined by researchers, such as blood pressure, blood sugar, and other test results. The evidence generated by PCOR can be used to develop performance measures, payment models, joint decisionmaking tools and other health care improvement efforts that are truly patientcentered.
[CAMH]: What is an example of an unintended consequence if patients are not engaged in these discussions?

Sheridan: As an example, if a payment model defined “value” mainly in terms of “clinical processes,” providers would strive to adhere to those and might actually be penalized, financially, for taking the time needed to understand their patients’ goals and engaging them in joint clinical decision making. Another example with a bundled payment model may include inadvertent incentives to administer care sparingly or in a “one size fits all” manner, not taking into account the unique needs of each individual patient. Additional research and including the patient voice in designing new payment models can help prevent such potential unintended consequences.

[CAMH]: How can patients effectively engage and get their voice heard?

•Patients need to identify existing opportunities to participate in health care reform at many levels.

• Once patients are engaged in reform dialogue, all stakeholders need to converse in lay language so that the reform dialogue is demystified and the dialogue productive.

• We must create a reform infrastructure that ensures the patient voice can be heard. Patients, caregivers, and patient and caregiver organizations must be at every table, working in partnership with the agencies that are developing measures of value and methods of payment.

• Patient and caregiver organizations must articulate their expectations that they will be at the table as partners and must help their affiliates and members to understand that their contribution to the APM dialogue will make a difference—to them and to patients like them.

[CAMH]: What is the current level of understanding among patients about APMs and/or payment reform efforts?

There is limited understanding in the patient community about the nature of ongoing payment reforms and their potential effects on patients’ care and outcomes. There have been few invitations to participate meaningfully in dialogue about such reforms. The patient community must be engaged if we are to improve care and outcomes that matter to patients and create a truly patientcentered health care system.

LAN Webinar: A Report from the Guiding Committee – June 10

Dana Gelb Safran and Dr. Barbara Spivak provided responses to your webinar chat questions

Guiding Committee Meetings

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.