March 1, 2017 – eNewsletter

Primary care accounts for more than 55 percent of the 1 billion physician office visits each year in the United States. According to a UnitedHealth Group report, although direct spending on primary care makes up a very small portion of national health care spending, decisions made by primary care professionals influence up to 90 percent of total health care costs through referrals to other doctors, clinical testing and procedures, and patient hospitalizations.

Poised to drive fundamental change in the health care delivery and payment system, PCPMs help to reduce the administrative burden of primary care, encourage team-based approaches to care and coordination, and allow for flexibility and innovation of value-based delivery approaches. The PCPM white paper lays out recommendations to facilitate this critical change.

Accordingly, the LAN has convened a new, multi-stakeholder Advisory Group to “refresh” the original APM Framework. Although there are many goals for this refresh effort, the primary ones are 1) to identify and create alignment between the Framework and Advanced APM designations under CMS’s Quality Payment Program (QPP); 2) to revisit category decisions for classifying APMs; and 3) to provide some new principles that support the first two goals.

Revised and refined category definitions will inform and support the 2017 progress measurement effort, which will be launched this May. As a basis for analysis, our goal for the 2017 effort is to increase both the breadth (in terms of number of lives covered) and depth (in terms of comparability across region and market segment) of the previous effort.

The LAN invites all health plans to contribute to our national understanding. With LAN support, participating plans will have an opportunity to have their programs represented in the national data sample that underwrites our awareness of APM adoption. Please contact Cathy Becker (cdbecker@mitre.org) with questions about participating in this critical initiative.

Some highlights from the session include:

• When making “the pitch” to senior leadership, Daverman stressed the importance of articulating that it can take several years to move from an idea to results with episodes, with a likely time frame of six months designing the episode, six months implementing, six months in a preview period, and one year in a performance period with a six-month wait for claims data (on which to evaluate the results) due to the claims data collection lag.

CPC+ regions vary in their data alignment approaches to support primary care practices. While some regions have already aggregated or are working toward aggregating payer data into unified reports to practices, others are generating aligned, but separate reports, sometimes as a short-term approach on the path to multi-payer data aggregation.

As part of the PAC’s mission to promote payer collaboration and shared learning on APMs, representatives of two CPC+ regions described their region’s journey toward multi-payer data aggregation or alignment. Common success factors include extensive communication and engagement among participating payers and the emergence of committed individuals to champion these efforts. Among common challenges is ensuring data is timely and actionable for practices. Learn more about how statewide efforts in Michigan and Arkansas are leveraging data to help transform primary care.

The DSRI is currently reaching out to organizations to gather insights on how they are succeeding with data aggregation in their particular market context, including how they experienced and overcame key challenges of governance, data sharing, and sustainability.

By focusing on capabilities and requirements needed for success with data aggregation, as well as current challenges and solutions, the DSRI aims to emphasize practical solutions, offer ideas for system-level scaling, and identify and share resources and learnings from diverse efforts. For more information about the DSRI, or to offer your perspectives, please contact Sarah Callahan (scallahan@mitre.org).