January 12 – Release of Final APM Framework White Paper
The Work Group, Guiding Committee, and CAMH team thank everyone who provided thoughtful feedback on the Alternative Payment Model (APM) Framework Draft White Paper. Please join us on Tuesday, January 12, from 12 – 1:30 pm ET for the public release of the final white paper. Don’t miss your chance to attend this webinar, where APM Framework and Progress Tracking (APM FPT) Work Group Chair, Sam Nussbaum, and Guiding Committee Co-Chair, Mark McClellan, will present the final paper and highlight important case studies. The APM Framework defines payment model categories and will be used to benchmark efforts to increase the adoption of APMs across the U.S. health system.
Rescheduled Webinar on Engaging Patients in APMs now on January 27
Join our rescheduled LAN Learnings webinar on Wednesday, January 27, from 12 – 1:15 pm ET to learn how to engage patients and family caregivers in APMs. This webinar features moderator and LAN Guiding Committee member Alan Balch (Patient Advocate Foundation). Other panelists include Michael Kolodziej (Aetna), Lauren Murray (National Partnership for Women and Families), Shelley Fuld Nasso (National Coalition for Cancer Survivorship), and Sara Van Geertruyden (Partnership to Improve Patient Care). This webinar will discuss how patients can serve as important partners in designing, implementing, and evaluating APMs.
The LAN hosted a webinar on December 16, 2015 to garner health care providers’ perspectives on the APM Framework Draft White Paper. Work Group members Paul Harkaway of Trinity Health and Shari Erickson of the American College of Physicians described the APM Framework to the panelists, and Grischa Metlay from the CMS Alliance to Modernize Healthcare (CAMH) team highlighted comments received to date on the paper. The panel discussed provider concerns with the proposed APM categories, how the white paper aligns with current Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Medicare Advantage initiatives, and how the white paper can be further refined to include other payment models such as primary risk-adjusted capitation.
We recently sat down with Hope Plavin, MPA, Director of theNew York State Department of Health Innovation Center and a LAN Committed Partner, to learn about her experience using APMs. Our conversation highlighted the challenges and successes of APMs and how the LAN can help accelerate their adoption. The New York State Department of Health Innovation Center is devoted to using government finance and policy levers to transform healthcare for New Yorkers by improving quality and access while also reducing cost.
On Monday, December 7, the LAN Guiding Committee (GC) heard updates from the Chairs of its three work groups. The Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group reported progress towards the final APM Framework White Paper, which will be released on January 12. The Clinical Episode Payment (CEP) Work Group shared its efforts to draft an outline on joint replacements, while the Population-Based Payment (PBP) Work Group offered updates on its existing sprints. GC members stressed the importance of transparency with regard to the use of data by patients for decision-making purposes, and discussed the potential need to create a new work group that could focus specifically on these issues. GC members also briefly discussed how the LAN can build on the many existing quality measure initiatives, and the importance of linking quality performance and total cost of care for APMs in categories 3 and 4. GC members agreed to participate in a special meeting in early January to discuss these issues. Read the GC meeting archives here.
Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group
On Friday, December 11, the APM FPT Work Group held a virtual meeting to discuss revisions to the APM Framework White Paper. A total of 113 comments, running 285 pages, were received from 79 unique individual or organizational participants. Of particular interest to the Work Group were recommendations about the need for more clarity regarding where and how certain groups will fit into the Framework. The Work Group is working to address this and is recommending a way forward to help stakeholders better understand how their models will fit into the Framework. Another point of discussion was a proposal to add an additional sub-category (4C) to the Framework to capture highly integrated payment and delivery systems, such as provider-sponsored health plans. The Work Group is including discussion of this issue in the final white paper.
The Work Group also received several comments about what qualifies as a sufficient incentive for motivating provider behavior changes in the context of APMs. The Work Group discussed the need to better understand this issue and what incentives might be appropriate over time. The final version of the white paper will be released on January 12, and the APM FPT Work Group will host a webinar the same day to present the paper, share some case studies, and encourage adoption of APMs. Please sign up here to attend. Learn more info about the APM FPT Work Group and view meeting archives here.
Population-Based Payment (PBP) Work Group
On December 14, the PBP Work Group met virtually to review draft recommendations and to consider outstanding issues from the group’s financial benchmarking and patient attribution sprints. Participants discussed the need to start with regional benchmarks because input prices are different in different areas of the country. Participants also discussed challenges in achieving financial benchmarking “convergence,” meaning that over time benchmarks are the same after adjusting for patient risk, input prices, and potentially, quality.
The Work Group also discussed the importance of benchmark risk adjustment, allowing data to be modified to control for variations in patient populations. Next, the patient attribution sprint presented highlights from its draft white paper, providing consensus perspectives for effective patient attribution in PBP models. This document will include a discussion of the potential benefits for patients in a PBP model, and the value of patient attribution to patients and other stakeholders. In keeping with the LAN’s mandate for transparency and inclusion, input on the work products of both sprints will be sought from key stakeholders before finalizing any white papers. Learn more and view the PBP Work Group archives here. Clinical Episodes Payment (CEP) Work Group
On December 15, the CEP Work Group held a virtual meeting to continue its work on developing a set of recommendations and options to facilitate adoption of joint replacement episode payment. The Work Group walked through preliminary recommendations from the November 16 in-person and December 1 virtual meetings and discussed additional written feedback. While the Work Group has made good progress since its kick-off on November 10, there are a significant number of questions and issues that will continue to be discussed by the Work Group. These issues include, how to design episode payment for a procedure in a manner that does not provide an incentive for overuse and applies to patients for whom the procedure is considered appropriate, how to adjust risk to ensure that providers do not have a disincentive to care for patients with complicated cases, and other challenges.
At this point, in order to facilitate completion of the joint replacement episode payment recommendations, the Work Group agreed to divide into two subgroups. One subgroup will consider design elements, and the second will further explore operational elements of joint replacement episode payment. The ultimate goal is to create a product that identifies not only a potential roadmap for joint replacement episode payment, but also elements of episode design that may be common across multiple conditions or procedures. In addition, the Work Group will begin researching examples of how episode payment is being used to provide high value care for cardiac and maternity patients, with the intention of launching these sprints early next year. View the CEP Work Group archives here.
Wishing you and your family a very happy holiday season! Thanks so much for everything you do to support the LAN. Without your hard work and participation, we wouldn’t be where we are today – leading the charge to promote better care, smarter spending, and healthier people. For more information on the LAN or to register yourself, visit our website.
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.