August 2, 2016 – eNewsletter – Health Care Payment Learning & Action Network

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NEWSLETTER | AUG. 2, 2016

{IN THIS ISSUE} Just Released: CEP Final Paper, Registration Now Open for LAN Summit, Help Answer Questions about Primary Care Payment Models

Final White Paper Outlines Three CEP Models

Yesterday, the LAN released its final white paper on Clinical Episode Payment (CEP) models. The paper, developed by the CEP Work Group that is chaired by Guiding Committee member Lewis Sandy, provides guidance for the design and implementation of CEP models. The paper outlines three specific clinical areas of focus – elective joint replacement, maternity care, and coronary artery disease – and offers guidance for providers, health plans, purchasers, and states on establishing CEP model components like episode timing, population, and accountable entities.

The recommendations highlight both design and operational considerations and offer a high-level roadmap for these models while leaving enough flexibility to allow for the implementation of models that are tailored to local markets. Ultimately, the paper addresses how CEP models can position patients and consumers – their clinical needs, values, and preferences – at the center of the health care system.

Read the paper

Next Week: Suite of Final PBP White Papers

On August 8, the LAN will release a suite of four white papers offering recommendations for implementing population-based payment (PBP) models. The four papers developed by the PBP Work Group and co-chaired by Glenn Steele and Dana Safran focus on foundational elements required to support a successful transition to PBP models: patient attribution, financial benchmarking, performance measurement, and data sharing. The papers offer multiple recommendations that stakeholders can implement now to accelerate the transition to APMs. Some of the key ideas in the papers include:

Using “big dot” outcome measures in performance measurement
That organization-specific benchmarks quickly converge on regional benchmarks
The gold standard is patient choice in patient attribution
Data should follow the patient, and population-level aggregate data should be a public good in data sharing

The PBP suite also provides the foundation for the new work of the Primary Care Payment Model (PCPM) Work Group that kicked off last month.

stay tuned

Leadership Corner

Next Phase of LAN Work

The LAN recently created several new initiatives to accelerate the adoption of APMs, including support for the implementation and testing phase of Work Group recommendations around alternative payment model designs on the ground. During the LAN’s recent Guiding Committee (GC) meeting on July 11, Mark Smith, co-chair of the GC, introduced the Action Collaboratives for Implementation, a new initiative comprised of health care stakeholders interested in accelerating the design and implementation of APMs in their states, regions, or localities. The first two groups operating under the Collaborative’s umbrella are the Primary Care Payer Action Collaborative (PAC) and the Maternity Multi-Stakeholder Action Collaborative (MAC).

Patrick Gordon, associate vice president of community integration for Rocky Mountain Health Plans, provided an overview of the PAC, offering a vision that will give payers and other stakeholders the opportunity to discuss challenges and solutions that are an inherent part of designing and implementing sustainable APMs in the primary care setting.

Deidre Gifford, director of state policy and programs at the National Association of Medicaid Directors, discussed the MAC, saying that the objective will be to support and facilitate the adoption of maternity care episode payment.

More information will be provided on the LAN website as the Collaboratives are established. If you would like more information on either the MAC or the PAC, please contact the Action Collaboratives Lead Tanya Alteras, talteras@mitre.org.

get involved

LAN Progress

Primary Care Work Group Kicks Off with In-Person Meeting

On July 13, the Primary Care Payment Model (PCPM) Work Group met in-person for the first time to discuss key issues surrounding primary care payment reform, share thoughts on initial recommendations, and plan strategy for the group’s expected white paper.

Co-chaired by Bill Golden, Guiding Committee member and medical director of Arkansas DHS/Medicaid, and Susan Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, the 22 member Work Group quickly focused on what a set of foundational principles should include.

The wide-ranging discussion explored the current challenges, multitude of settings, and opportunities that Comprehensive Primary Care Plus (CPC+) and new private sector models pose. The prevailing sense of the group is that preventative services are underutilized, leading to greater incidence of precursors for chronic disease; that patients are referred to specialists for procedures and services that do not provide much value; and that consistent high quality health outcomes are lacking for the amount of resources consumed.

The group discussed initial ideas for principles to guide the development of their recommendations on primary care payment models. Some of the suggestions included the idea that payment should support the delivery of primary care by teams of health professionals and promote the integration of care and community resources.

To help inform these principles and recommendations, the Work Group would like input on the following initial question: What is your experience (or challenge) with payment for care in alternative settings outside the primary care physician’s office (such as virtual visits, phone consultations, retail clinics, employer-based clinics, etc.)? Please respond to hcplan-pcpm@mitre.org with your thoughts by Monday, August 15.

get in touch

Your Help is Needed for Payment Evaluations

For payment and care delivery reforms to succeed, more evidence is needed on which models work in today’s complex health care environment. To fill this gap, the Duke-Margolis Center for Health Policy, with support from the Laura and John Arnold (LJAF) Foundation, launched the Payment Reform Evidence Hub. The Hub seeks to disseminate lessons learned from existing evaluations, provide tools that organizations can use when considering evaluating their initiatives, and coordinate new evaluations of promising care delivery and payment models.

While many evaluations may not be public yet, the Hub would like to learn of any that your organization has completed and about payment initiatives that have not been evaluated (past, present, or future). Contact the Hub if interested in getting an evaluation for an upcoming payment initiative. The Hub can supply evaluation expertise and help with understanding the impact of the initiative (including what factors are necessary for success).

If interested, fill out this survey to let the PRE Hub know the basics about your payment reform initiative, and they will follow up with you to learn more. If you have questions, please contact Rob Saunders at robert.saunders@duke.edu.

take the survey

Patient & Consumer Checklist for APM Implementers

The Consumer and Patient Affinity Group (CPAG) Leadership Committee held a virtual meeting on July 26 to discuss the CPAG Principles Checklist, which will build on the CPAG’s Principles for Patient- and Family-Centered Payment. Scheduled for release in the fall, the checklist will help LAN Work Groups and implementation projects assess whether they have incorporated the CPAG principles into their work products to ensure that the needs and priorities of patients and families are addressed during the transition to value-based payments.

LAN News

Join Our Twitter Chat!

We are hosting a Twitter Chat this month to discuss primary care payment models. Join us for this opportunity to weigh in with Work Group co-chairs Bill Golden and Susan Edgman-Levitan and share your thoughts on advancing APMs for primary care. Stay tuned for more information, including date and time. If you are interested in participating, please send us an email at paymentnetwork@mitre.org or tweet us @PaymentNetwork.

stay tuned

Of Interest

HHS Proposes New Payment Models

The U.S. Department of Health & Human Services (HHS) recently announced new payment models to advance progress towards APM adoption. The proposed rule includes new bundled payment models for cardiac care, an extension of the existing bundled payment model for hip replacements, a new model to increase cardiac rehabilitation utilization, and a proposed pathway for physicians under the Quality Payment Program.

Issue Brief on Price Transparency in Health Care

A new brief from AcademyHealth highlights key findings about the impact of price transparency in health care. With support from the Robert Wood Johnson Foundation (RWJF), the research points to the effect of price information availability on both consumer and clinician health expenditures and shows how the consolidation of heath care markets affects health prices. While consumer demand for price information is growing, studies find that price comparison tools are underused. And, in contrast to previous research, RWJF grantees found that clinicians do not reduce ordering rates when given price information at the point of care.

Summer Series from Catalyst for Payment Reform

The Catalyst for Payment Reform (CPR) is hard at work helping employers and other health care purchasers pursue value with their health care dollars. This month, CPR invites you to join them for their free webinar series. Subject matter experts will come together to explore key issues and looming changes in benefits and provider payment for telehealth, behavioral health, maternity, and care management and navigation. For more information about the upcoming webinars, visit CPR’s event website.

Health Care Payment Learning & Action Network

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.