In the coming weeks, the LAN will release a suite of final white papers that offer recommendations for developing and implementing population-based payment (PBP) and clinical episode payment (CEP) models. The LAN received more than 240 comments, and these have been integrated into the final papers.
The final versions of the four PBP papers that will be released focus on foundational elements required to support a successful transition to PBP models – patient attribution; financial benchmarking; performance measurement; and data sharing. The updated papers incorporate suggestions from LAN participants on ways to engage patients at every stage, use PBP models in a variety of care settings, identify challenges and resource impact of transitions between care settings, provide a more inclusive approach to how social determinants of health are included in performance measurement approaches, and expand who is part of data sharing.
The final CEP white paper will focus on three specific episodes: elective joint replacement, maternity care, and coronary artery disease (CAD). In response to public comments, recommendations on episode timing and determining the accountable entity were revised across the three episodes. In addition, the episode definition and population for the maternity care episode was revised. Finally, the payment flow recommendation is now, in response to comments received, specific to each episode, depending on the episode design and clinical focus area. The three sets of recommendations are designed to strike a balance between what is feasible in today’s health care system with what is innovative and aspirational.
The final suite of PBP and CEP white papers provides an important resource for accelerating the adoption of alternative payment models (APMs) nationwide with patient-centered approaches. Stay tuned for the release of the final white papers on July 25 (CEP) and August 8 (PBP).
The LAN is excited to announce the Fall LAN Summit will be held on October 25 in Washington, DC. We hope you will join hundreds of other innovators and leaders to learn about implementing APMs and share lessons learned. More information coming soon!
On June 15, the Guiding Committee (GC) met by teleconference to discuss the LAN’s progress during the past year and to map out the next steps for its Work Groups. As the LAN moves into its second year, efforts will focus on implementation of its recommendations, as well as payment models that support and enable effective and innovative delivery of primary care. Stay tuned for more information.
Primary Care Payment Model Work Group Hosts Initial Kick-Off
The Primary Care Payment Model (PCPM) Work Group kicked off its work on June 23. Co-chairs Susan Edgman-Levitan and Bill Golden provided an introduction to the guiding principles that were established by the GC to inform the efforts of all LAN Work Groups and shared how primary care was identified as a key priority for LAN attention. The Work Group utilized its initial discussion to develop a preliminary list of issues to be addressed. The Work Group will hold its first in-person meeting on July 13 in Washington, DC.
New Action Collaboratives to Drive Implementation of APMs
The LAN is kicking off the Action Collaboratives for Implementation (AC), which will focus on translating the recommendations developed by the PBP and CEP Work Groups into action. The goal and challenge of the AC is to bridge the gap between the conceptual themes described in the final PBP and CEP white papers and the technical and operational needs of implementers. Building on the LAN’s recommendations and representing a diverse set of committed partners, subject matter experts, and stakeholders working toward alignment, the AC will seek to 1) raise awareness and engagement of LAN recommendations across stakeholders; 2) facilitate collaboration and shared learning to align APM operational models; and 3) capture and package outcomes of implementation efforts into practical tools.
The AC will begin by focusing on two areas, and more will be added as opportunities arise. The first is the Maternity Multi-Stakeholder Action Collaborative which will facilitate coordination and collaboration among payers and purchasers (commercial, Medicaid, and state employees); and others to accelerate adoption of maternity care payment models. The second is the Primary Care Payer Action Collaborative which will engage payers participating in multi-payer primary care APM initiatives (e.g. the Comprehensive Primary Care Plus program (CPC+)) to discuss and work on operational challenges. This forum will facilitate shared learning toward the goal of implementing sustainable primary care APMs.
The LAN is actively seeking interested stakeholders to participate in this exciting new work. If you are a state, commercial payer, or purchaser and would like more information, please contact Tanya Alteras at firstname.lastname@example.org.
The Payment Reform Evidence (PRE) Hub met in-person on June 20 to review its progress and inventory of payment reforms. The PRE Hub is a national collaborative working to identify and implement specific short-term steps to enable evaluations that are transparent, fast, cheap, and reliable. Members provided feedback on a draft questionnaire crafted for potential delivery and payment reforms, and the PRE Hub will soon release a survey to identify potentially promising delivery and payment reforms. Members also gave input on best practices for evaluating these reforms. These best practices, including data access and methods, will be summarized in an upcoming white paper. For more information or to suggest a delivery or payment reform evaluation for the inventory, please contact Rob Saunders at Robert.email@example.com.
The U.S. Department of Health and Human Services (HHS) recently announced a selection of nearly 200 physician group practices and 17 health insurance companies to participate in the first Centers for Medicare & Medicaid Services (CMS) physician-led specialty care model. Known as the Oncology Care Model, this model supports and encourages higher quality and more coordinated cancer care for those with Medicare coverage. Nearly twice the originally expected number of physician group practices will be involved with the model, which is an encouraging sign of provider enthusiasm for these kinds of APMs.
The LAN continues to add leading organizations to its roster of Committed Partners—organizations that have established their own goals in support of APM adoption and shared them with the LAN. We are thrilled to announce the addition of Aetna, Arkansas Blue Cross Blue Shield, Centra Health, Great Plains QIN Category Quality Improvement, M3 Information, and Vizient. Read more to learn how your organization can become a LAN Committed Partner.
Recap of LAN Listening Session: Opportunities & Challenges in Data Sharing for PBP Models
On June 20, the LAN held a webinar to hear public feedback about the recommendations of the draft data sharing white paper. PBP Work Group Co-chair, Glenn Steele, and PBP Work Group member, David Muhlestein, facilitated the discussion with over 75 attendees from various stakeholder groups. The discussion focused on several issues:
Ways payers and providers can be incentivized to cooperate in data sharing arrangements.
Challenges currently hampering the development of data sharing arrangements, including regulatory barriers and the changing proprietary nature of data.
How the work group’s recommendations might be implemented to achieve alignment while also meeting the needs of various markets.
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.