October 13, 2015 – eNewsletter

{IN THIS ISSUE}

  • LAN Learnings in October
  • Guiding Committee Update
  • Upcoming Webinars
  • Work Group Corner
  • Stakeholder Event

Join us October 15 from 12:30-1:45 PM ET for the “LAN Learnings in October” webinar to get updates on LAN activities and hear about an innovative payment reform approach focused on low income and vulnerable populations in New Jersey.

The LAN Guiding Committee has been working to launch new work groups, stand up affinity groups, and prepare for the first LAN Summit in Arlington, Virginia. LAN Guiding Committee Co-chair Mark McClellan will share updates on these activities during this webinar.

In the second part of the webinar you will hear from panelists discussing the Medicaid payment reform initiative occurring in New Jersey. This model promotes accessible, coordinated, patient-centered care that focuses on health and disease prevention and reduces health care costs. Hear perspectives from: 

  • Edith Calamia, Chief Medical Officer of Unitedhealthcare;
  • Derek DeLia, Associate Research Professor/Senior Health Economist of Rutgers Center for State Health Policy; and
  • Mark Humowiecki, General Counsel & Director of External Affairs of the Camden Coalition of Healthcare Providers.

Panelists will discuss how New Jersey has implemented this model, how it is working, what lessons have been learned, and plans for evaluation and performance feedback to Accountable Care Organizations (ACOs).

Register for LAN Learnings in October 

Participants in a conference room

On September 30 and October 1, the Guiding Committee held a two-day in-person meeting to discuss the status of LAN activities and several new areas of focus.

Some topics covered during the two-day meeting included:

  • Update on the APM Framework and Progress Tracking Work Group
  • Moderated Panel: Lessons from other Public-Private Partnerships
  • Update and Discussion about the two new work groups: the Population-Based Payment (PBP) and Clinical Episode Payment (CEP) Work Groups
  • Update on the LAN Affinity Groups focused on Purchasers/Employers and Consumers/Patients
  • Communications, Engagement and Connecting with Stakeholders
  • Update on the In-Person LAN Summit Scheduled for October 26
  • Overview of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA)

Committee members welcomed two new members: Sally Welborn, Senior Vice President, Global Benefits, Walmart Stores, Inc., and Dorothy Teeter, Director, Washington State Health Care Authority, who will be replacing outgoing members.  A robust discussion generated feedback on the draft APM Framework White Paper, which will be released to LAN participants for comment the week of October 19. Members reviewed and discussed the objectives and scope of the two new work groups (see below) and reviewed general implications of the MACRA law and its relationship to the LAN. The committee identified collaboration opportunities with other efforts focused on payment reform. Members also brainstormed ways of engaging organizations in commitments to LAN APM recommendations when those become available. The meeting summary will be posted on the LAN website in the coming weeks.

                                  

Save these dates for upcoming webinars

October 15   12:30 – 1:45 PM ET
November 10  1 – 2:15 PM ET
December 2   2 – 3:15 PM ET
Stay tuned for topics and registration links.

APM Framework and Progress Tracking Work Group

The APM Framework and Progress Tracking (APM FPT) Work Group met on September 18 and October 5 to collectively finalize the draft APM Framework White Paper in anticipation of its release the week of October 19.

The White Paper explains why the work group believes that a shift towards population-based payments is a necessary step to achieving patient-centric healthcare in the United States. The White Paper also describes the approach that the work group used to develop the APM Framework, and then delineates and describes principles upon which the APM Framework is based. With these principles in mind, the White Paper differentiates the categories within the APM Framework by explaining how the categories are defined and where the boundaries between them lie. In order to further clarify the classification of individual APMs, case studies are used to exemplify each of the categories and subcategories in the APM Framework. The White Paper concludes with a summation of the work group’s key findings and recommendations.

he work group will be releasing the draft White Paper on Handshake a few days prior to the October 26 LAN Summit and collecting comments through early November. The LAN Summit is a great opportunity to hear directly from work group members on the White Paper and to provide feedback.

 

Population Based Payment (PBP) Work Group Co-Chairs Appointed

We are pleased to announce Dana G. Safran, ScD, Senior Vice President Performance Measurement and Improvement, Blue Cross Blue Shield of Massachusetts and Glenn Steele, Jr, MD, PhD, Chairman, xG Health Solutions, Inc., and immediate past President and CEO, Geisinger Health System as co-chairs of the PBP Work Group.

Safran_Dana

Dana Gelb Safran, Sc.D., is Senior Vice President for Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts (BCBSMA). In this role, she leads the company’s initiatives to measure and improve healthcare quality, safety, and outcomes.

Dr. Safran was among the lead developers of the BCBSMA Alternative Quality Contract (AQC), a provider contract model launched in 2009 with the twin goals of improving quality and outcomes while significantly slowing spending growth.

She also retains an active academic practice, as a faculty member in the Department of Medicine at Tufts University School of Medicine, and has authored more than 75 peer-reviewed articles. She is widely recognized as having contributed to the empirical basis for our nation’s push toward a more patient-centered health care system – and for developing measures of patient care experiences that are now used nationwide, accepted as a national standard for this area of measurement, and used by the Medical Boards as part of their recertification process for physicians.

Q: Why was the PBP Work Group created?

The PBP is one of several work groups supporting the overall goals of the LAN.   The specific charge of the PBP work group is to identify a set of program elements for which alignment on approaches among public and private payers could accelerate provider adoption of payment reform, and for each topic, to develop a consensus view of best practices.

Q: Why have you committed to chair this group?

The public and private sector momentum to reform health care payment is significant.   Understanding of the failings of fee-for-service payment and the economic imperative to achieve better care at lower costs has never been clearer.   I am proud to be part of the leadership that is helping to seize this important moment to improve health care quality, outcomes and affordability through advancing population-based payment.

Q: What do you see as the main challenges facing the group?

We need to strike the right balance in our work and not become overly prescriptive or granular about what the “right answers” are. The truth is that payers and providers are still learning what works in population-based payment, and best practices today may give way to new lessons learned tomorrow. Our work has to, therefore, provide sufficient clarity and guidance to support accelerated adoption of PBP models while not stifling innovation.

Glenn Steele

Glenn D. Steele Jr., M.D., Ph.D., serves as Chairman of xG Health Solutions, an independently operated venture launched by Geisinger Health System to help healthcare organizations create value and improve quality, leveraging Geisinger intellectual property and expertise on issues such as population-health data analytics, care management and health IT.

Dr. Steele is the former President and Chief Executive Officer of Geisinger Health System, an integrated health services organization in central and northeastern Pennsylvania, nationally recognized for its innovative use of the electronic health record and the development and implementation of innovative care models.

Q: Why have you committed to chair this group?

Two reasons. First, the task is worthy. Second, without establishing fundamental consensus on key methodology, such as attribution and financial benchmarking, there will be no sustainable conversion from fee-for-service to population-based payment options. 

Q: What is the first thing you see the work group tackling to begin its work?

The first task will be to prioritize our expected outcomes. If we agree on three or four underlying methodologies to be applied both to the public as well as the private payers that move what is now a hospital-centric interventional fee-for-service business model to population health outcome based options, we will have accomplished our task.

Q: What do you see as the main challenges facing the group?

I believe the main challenge will be achieving the right balance between presumed “perfect” solutions and stepwise improvements that will tolerate the expected messy, iterative, and evolving transactions in the real world of public payer and commercial payer/provider interactions.

Q: How will you engage the LAN for input on the group’s work?

We’ll engage the LAN in two ways. First of all, we will use expertise, not only within health care, but obtained from other complex systems. And second, we will take advantage of the health care stakeholder composition so that when consensus is achieved on ways forward, we can expect the concepts to be taken into the field and used.

 

Clinical Episodes Payment (CEP) Work Group Chair Appointed

Sandy_Lewis

We are pleased to announce Lew Sandy, M.D., as chair of the CEP Work Group. Dr. Sandy is Senior Vice President, Clinical Advancement, at UnitedHealth Group. His work focuses on clinical innovation, payment/delivery reforms to modernize the health care system, and physician collaboration. He also is a principal in the UnitedHealth Center for Health Reform and Modernization, with a focus on payment/delivery innovation and policy.

 

 

LAN Summit logo

Join fellow innovators from health systems, health plans, purchasers/employers, federal and state government, consumer groups, patient advocates, experts and others who are designing or have implemented alternative payment models. Several important things to note as the event draws closer:

Andy Slavitt

  • Keynote by Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services
  • Registration is filling up fast. If you plan to attend, please register today.
  • Agenda is Live. The new LAN Summit website contains detailed information on the agenda, speakers, hotel, transportation, local food options and more.
    • Enjoy seven breakout sessions on a range of case studies
    • Join brown bags by sector to learn and share with colleagues
    • Choose Payment Primers or Leadership Listening sessions
  • Special session on LAN and MACRA: Understanding the Connection
  • Presentation of the APM Framework White Paper. The APM Framework and Progress Tracking Work Group will be releasing its White Paper for comment the week of October 19. Plan to provide your input, then attend the APM Framework session the morning of October 26.
  • Tweet Us. We want to hear what you are most looking forward to learning about at the Summit. Tweet @Payment_Network using #LANSummit.
CAMH Team Members banner

Anne Gauthier, Project Leader

Amy Aukema, Deputy Project Leader

Kris Prendergast, Communications Lead

Chris Izui, Work Group Lead

Grisha Metlay, Work Group Subject Matter Expert

Karen Milgate, Work Group Subject Matter Expert

Jamel Morris, Work Group Lead

Hillary Peabody, Work Group Lead

Heather Grimm, Communications Specialist

Collin Scheible, Healthcare Analyst and Project Coordinator

Mary Jo Deering, Consultant

Heidi Giles, Program Manager

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.

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