January 26, 2016 – eNewsletter




eNewsletter  |  January 26, 2016  |  PaymentNetwork@MITRE.org


Feature Stories

Health Affairs Blog Spotlights New APM Framework

APM FrameworkHealth Affairs recently published a new blog about the APM Framework White Paper co-authored by Sam Nussbaum, Chair of the Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group, Mark McClellan and Mark D. Smith, Co-chairs of the Guiding Committee (GC), and Patrick Conway, GC member and Chief Medical Officer for the Centers for Medicare & Medicaid Services (CMS) and Director of the Center for Medicare & Medicaid Innovation. The guest blog describes the recent APM Framework White Paper and highlights the importance of delivering high-quality, cost-effective person-centered health care. The Framework builds on the original APM structure developed by the Department of Health and Human Services (HHS) and articulates key principles and guidance on how to define and categorize APMs.
Read the Blog

Don’t Miss Tomorrow’s LAN Learnings Webinar: Building a Patient-Centered Health System

APM FrameworkJoin 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), 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. 

Recap of APM Framework Webinar and Recording

APM Framework WebinarIn case you missed it, on Tuesday, January 12, the LAN released the final APM Framework White Paper. In this recorded webinar, Sam Nussbaum, Chair of the APM FPT Work Group, and LAN Guiding Committee Co-Chair, Mark McClellan, presented the White Paper, while several organizations presented case studies, including Integrated Healthcare Association, Intermountain, Centers for Medicare & Medicaid Services (CMS), and Capital District Physicians’ Health Plan, Inc. These case studies are available in the Addendum to the APM Framework White Paper. During the webinar, the panel addressed comments on a diverse range of APM topics. Stay tuned for follow-up questions and answers, which will be made available soon. Here are the slides from the presentation. 

Register for LAN Update Webinar on Patient Attribution and Financial Benchmarking

Please join us on Tuesday, February 9 as the LAN hosts a webinar presentation to discuss the release of draft white papers for public comment from the Population-Based Payment (PBP) Work Group, highlighting two main issues: patient attribution and financial benchmarking. Work Group Co-chair Dana Gelb Safran and sprint leaders Amy Nguyen Howell and Michael Chernew will describe patient attribution, the method by which patient populations are assigned to providers who are accountable for total cost of care and quality outcomes for their designated populations in a PBP model. The panel will also illustrate the ways payers adopting PBP models can use financial benchmarking to improve accountability, compare performance across sites and over time, and reward high-performing providers.

LAN Learnings February: Value-Based Payment for Managing Individuals Living with Chronic Illness 

Next month’s LAN Learnings webinar will be conducted in partnership with the Health Care Transformation Task Force. Join us Wednesday, February 24, from 12 – 1:15 pm ET to learn about innovative payment models for care management of people who live with chronic illness. This webinar features moderator Jeff Micklos (Health Care Transformation Task Force) and panelists Diane Stewart (Pacific Business Group on Health) and Greg Jones (Aetna). The presentation will take a deep dive into innovative payment models for this population and also touch upon how to identify and target individuals living with chronic illness for care management services.

Spotlight Interview

Greenville Health System: An Active Player in Payment Transformation 

APM Framework Webinar“We envision a consolidated, clinically integrated network across our state with a single care model, a single data warehouse, single metrics for success, and unified processes that fully engage patients.” – Dr. Angelo Sinopoli

Greenville Health System (GHS) has been a committed LAN partner since March 2015. We talked recently with the Vice President for Clinical Medical Integration and Chief Medical Officer at GHS, Angelo Sinopoli, MD. Along with being a LAN Guiding Committee member, Dr. Sinopoli is President of the GHS clinically integrated network, MyHealth First, and President of the Care Coordination Institute (CCI), an organization dedicated to helping health care providers throughout the Southeast thrive in a population health management environment. Participating also in the conversation were John Supra, CCI Executive Director of Operations; Valinda Rutledge, CCI Vice President of Public Payor Health Strategy; and Jennifer Snow, Director of Accountable Communities for GHS.

Read the Interview

Upcoming Events

Save these dates for upcoming webinars

January 27, 12 – 1:15 pm ET  LAN Learnings: Building a Patient-Centered Health System
February 9, 12 – 1:30 pm ET  LAN Update: Patient Attribution and Financial Benchmarking
February 24, 12 – 1:15 pm ET  LAN Learnings: Value-Based Payment for Managing Individuals Living with Chronic Illness

Learn more about previous webinars and view our webinar archive.

LAN Summit

Registration and Call for Abstracts Opening Soon

LAN SummitMark your calendars for the Spring LAN Summit on April 25-26, 2016. We hope you will attend! Please consider submitting an abstract or offering a suggestion for a session topic. Registration and a call for abstracts will open soon – stay tuned.
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LAN Progress

More Resources for Alternative Payment Model Framework

APM FPTFollowing the successful January 12 roll-out of the Alternative Payment Model (APM) Framework White Paper, the APM Framework and Progress Tracking (APM FPT) Work Group has been busy preparing a wide range of supporting materials to assist stakeholders such as patient advocacy groups, providers, health care plans, and purchasers in gaining insight about APMs and better understanding where different models fit. In addition to the White Paper itself, the Work Group has developed a one-page diagram illustrating the APM Framework in detail, a set of case studies designed to illustrate the likely ways in which real world APMs will be categorized in the APM Framework, and FAQs with additional information. These and other resources can be found here.
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Comment Period Opens Soon on Patient Attribution and Financial Benchmarking Draft White Papers

PBPOn January 20, the Population-Based Payment Work Group met for a day-long working session focused on the simultaneous development of four white papers. The work products address four key areas that support PBP models focused on quality as well as total cost of care: patient attribution, financial benchmarking, data sharing, and performance measurement.

The group kicked off the day with a discussion about how to finalize two white papers that are currently in development. The first paper offers ten principles that can guide payers and providers as they adopt and use PBP models by recommending guidelines for how public and private payers can effectively handle attribution in their models. The second paper describes approaches to financial benchmarking that encourage innovation and alignment in how PBP models set and update benchmarks, even for payers and providers who are at different stages in the adoption of the models. Both papers will be submitted to the Guiding Committee and will be released for public comment on February 8.

The Work Group also developed preliminary recommendations which will be included in two additional draft white papers addressing data sharing and performance measurement. During a series of afternoon break-out sessions, the Work Group clarified the scope of these papers and set goals for what each paper will address. The performance measurement white paper will build on the substantial work to date on developing measurement frameworks and core measure sets. Work Group members believe that new measurement systems are needed to ensure the sustained success of PBP models and to advance better results for patient populations. The white paper will include a set of recommendations on the evolution of measurement systems to reward provider performance and improvement. The data sharing white paper will focus primarily on payer and provider data exchange that is needed to monitor performance. The paper will identify common barriers and impediments to data sharing as well as case studies illuminating cutting-edge practices.The PBP Work Group intends to move quickly on these work products; the data sharing and performance measurement white papers will be released for public comment in late April 2016.

Throughout the comment periods for each of the four white papers, the LAN will be holding webinars and listening sessions for the LAN community, including providers, purchasers, consumer groups, and states to ensure that the Work Group has the opportunity to hear the perspectives of all stakeholders. Please stay tuned to learn how you can participate.

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CEP Work Group Readies Draft Elective Joint Replacement White Paper

CEPThe Clinical Episode Payment (CEP) Work Group is continuing to develop and refine recommendations for the design of an episode payment model for elective joint replacement. The goal is to create a model that spurs adoption of this form of alternative payment for a high-volume, high-cost procedure.

The white paper will feature a set of foundational principles and capture the end goals for episode payment, including incentivizing person-centered care and improving patient outcomes via effective care coordination. Other end goals include reducing inappropriate use of procedures and reducing unnecessary costs to the patient and to the health care system. The design element recommendations for this joint replacement episode—as well as future episodes on cardiac care and maternity care—tie back to the original principles. The overarching goal of the recommendations is to promote clinical episode payment adoption across a broad set of players and providers with support from consumers, patients, states, and private sector purchasers.

On January 19, the CEP Work Group participated in a virtual meeting to discuss the principles, recommendations, and overall tone and level of detail in the draft White Paper. Members provided valuable input on language related to the clinical episode start point and length, patient population and included services, patient engagement provisions, provider accountability, and the type and level of risk. In addition, members discussed the need for language in the paper that describes contextual or system-level issues that need to be addressed to broadly support implementation of episode payment. The draft White Paper will be released for public comment on February 17.

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LAN News

New Consumers and Patients Affinity Group
CPAGEngaging patients, family caregivers, and consumers in APMs is key to building a patient-centered health system. The LAN recently formed a new Consumers and Patients Affinity Group (CPAG) as a channel for consumer and patient advocacy groups to provide important insights into the impact of APMs on patients and consumers, describe better health outcomes from the perspective of consumers and patients, and define the care experience that APMs should deliver. Representatives of consumer and patient organizations are encouraged to join the dedicated group on Handshake, the LAN collaboration portal. The CPAG Leadership Committee, co-chaired by three consumer or patient representatives on the LAN Guiding Committee – Alan Balch, Patient Advocate Foundation; Nancy LeaMond, AARP; and Debra Ness, National Partnership for Women and Families – will help identify consumer priorities and principles for APMs and inform the work of the Guiding Committee and Work Groups.
Payer Collaborative Kick-Off

Payer CollaborativeThe LAN Payer Collaborative held its first virtual kick-off meeting on January 21. The Collaborative brings together industry leaders representing diverse public and private health plans, including various groups of payers of different size, representing different markets, and with different geographic reach. The Collaborative’s mission is to inform the LAN’s approach for measuring progress of APM adoption against the LAN’s goals of 30% adoption by 2016 and 50% adoption by 2018.

Much of the meeting was spent on introducing group members and reviewing both the APM Framework described in the recently released white paper as well as the proposed metrics and methods for measuring progress toward APM adoption. A detailed discussion of the metrics identified the need for clarification on how to conduct the calculations and began to explore how to operationalize the APM Framework from a reporting standpoint. The meeting concluded with a call for volunteers to participate in a 5-week pilot on the metrics that is scheduled to begin in mid-February. The pilot will test the feasibility and timing of the approach and provide important feedback on the need for any clarifications. A follow-up meeting of the Payer Collaborative is scheduled for February 4.

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.