Paying Providers For Value: The Path Forward (Update)
- April 19, 2016
- Posted by: Health Care Payment Learning & Action Network
- Category: Blog
This post originally appeared on the Health Affairs blog.
Health plans have an important opportunity to lead the way in gauging where we stand as a nation on the pathway to payment reform. In mid-May, the Health Care Payment Learning & Action Network (LAN) will launch an eight-week nationwide data collection program with public and private plans, concluding in mid-July. This initiative follows the development of the APM Framework by the LAN’s APM Framework and Progress Tracking Work Group in January of this year. The results of this effort will help the LAN assess progress toward its goal of 30% adoption of APMs by 2016 and 50% by 2018 for the U.S. health system.
To gain a more complete picture of APM adoption nationwide, the LAN is recruiting 200–300 public and private health plans nationwide to participate alongside several of the larger health plans that have already joined the APM data collection effort. Those who participate will help to advance understanding of the current state of payment innovation, and provide insights to advance effective payment reform for the future. This LAN initiative to measure APM adoption is a key activity in our collective efforts to transform heath care to better care, healthier people, and smarter spending.
To participate in this crucial effort, send an email to paymentnetwork@mitre.org.
Please note that guest blogs from Guiding Committee and Work Group members represent the views of the individual authors and do not represent official positions of the Guiding Committee, Work Groups, CAMH, or CMS.
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Sam Nussbaum, MD
Dr. Nussbaum serves as Chair of the Health Care Payment Learning & Action Network’s Alternative Payment Model Framework & Progress Tracking Work Group. He is former Executive Vice President and Chief Medical Officer of Anthem.
Patrick Conway, MD, MSc
Dr. Conway serves as a member of the Health Care Payment Learning & Action Network’s Guiding Committee. He is Chief Medical Officer for the Centers for Medicare & Medicaid Services and Director of the Center for Medicare & Medicaid Innovation.
Mark McClellan, MD, PhD
Dr. McClellan serves as Co-chair of the Health Care Payment Learning & Action Network’s Guiding Committee. He is Director of the Robert J Margolis Center for Health Policy and Robert Margolis Professor of Business, Medicine and Health Policy at Duke University.
Mark Smith, MD, MBA
Dr. Smith serves as Co-chair of the Health Care Payment Learning & Action Network’s Guiding Committee. He is Visiting Professor, University of California at Berkeley, and Clinical Professor of Medicine, University of California at San Francisco.
Policy Makers
Enabling Organizations | 
Community-Based Organizations
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
