February 9, 2016 – eNewsletter

The public comment period for the first two draft white papers from the Population-Based Payment (PBP) Work Group opened on Monday, February 8 and will run through Monday, March 7. The PBP Work Group invites your input on these drafts to help ensure they reflect the needs of the U.S. health care community.

The draft white paper, Accelerating and Aligning Population-Based Payment Models: Patient Attribution, describes 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 paper recommends that active, intentional identification or self-reporting by patients should be considered first. The paper also outlines nine additional recommendations that payers and providers can use when making decisions on attribution in their PBP models.

The draft white paper, Accelerating and Aligning Population-Based Payment Models: Financial Benchmarking, describes approaches for setting an initial benchmark and updates over time and also addresses risk adjustment considerations. The white paper discusses the need to balance voluntary participation with the movement towards convergence in a market with providers at different starting points.

The PBP Work Group seeks feedback on the overall white papers and recommendations; diagrams, flowcharts, and tables used to illustrate key concepts; and examples that would be useful for illustrating the recommendations. The PBP Work Group will be collecting feedback online through a discussion forum on Handshake and on the LAN website at www.hcp-lan.org. Both white papers are targeted for release in early April. 

Please join us this afternoon for a virtual presentation on the PBP Work Group’s draft white papers on 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.

The Guiding Committee (GC) held an in-person, all-day meeting to discuss new opportunities that the LAN should pursue during its second year; to explore synergies between the LAN and the CMS State Innovation Models (SIM) initiative; and to gather feedback and provide guidance on the LAN’s three draft white papers. GC members also provided updates on what the LAN is doing to engage purchasers and consumer and patient groups. 

To prioritize the LAN’s efforts for its second year of operations, GC members discussed and considered a set of options, based on what emerged in previous GC meetings, was recommended by experts in the field, or was suggested by LAN participants through a variety of mechanisms. The GC strongly emphasized the importance of building on the Work Groups’ written recommendations to test and implement the LAN’s recommendations in partnership with payers and providers. The CMS Alliance to Modernize Healthcare (CAMH) will consider the strategic guidance provided by the GC as it develops a strategy for the LAN’s second year of operation. 

On February 2, the Clinical Episode Payment (CEP) Work Group held a bi-weekly teleconference and reviewed feedback on the draft elective joint replacement white paper. The Work Group received positive feedback from the GC on the White Paper and discussed several issues for further refinement. These included quality measures that could support joint replacement episode payment, the need for better tools to support patient decision-making, and a potential appendix to outline, at a high-level, the way recommendations could be implemented in various market scenarios. The white paper will be released for public comment later this month.

The Consumer and Patient Affinity Group (CPAG) held a virtual meeting on January 26. CPAG Co-chairs Nancy LeaMond (AARP) and Debra Ness (National Partnership for Women and Families) led participants in a discussion of six high-level consumer and patient principles to inform and guide the work of the GC and Work Groups. Several suggestions were offered to further engage patients, family caregivers, and consumers in APMs to build a more patient-centered health system. Participants also discussed new candidates from health equity organizations who could participate in the CPAG. The group reached consensus on inviting Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum (APIAHF). The meeting closed with a discussion of the draft elective joint replacement white paper, which seeks to include the consumer and patient perspective in recommendations for designing episode payments for elective joint replacement.