March 1, 2017 – eNewsletter – Health Care Payment Learning & Action Network

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NEWSLETTER | MAR. 1, 2017

Feature Story | LAN Blog | Virtual Forum | LAN Progress

{IN THIS ISSUE} APM Framework Refresh Effort Underway, Primary Care Payment Model (PCPM) White Paper Released, Making Health Care Responsive to Patients

Accelerating and Aligning Primary Care Payment Models

Today, the LAN released a final white paper, Accelerating and Aligning Primary Care Payment Models, developed by the Primary Care Payment Model (PCPM) Work Group. A result of multi-stakeholder collaboration and public input, the paper outlines recommendations for public and private payers to align their payment approaches for primary care.

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.

Read the paper

LAN Blog

Nancy LeaMond
AARP

Making Health Care Responsive to Patients

by Nancy LeaMond

With increasing concern over climbing health care costs, shifting health payments into alternative payment models (APMs) is more important now than ever before. In this latest blog, read how educating patients and other stakeholders on patient-centered care can help accelerate the design and implementation of payment models that prioritize the needs of patients and family caregivers.

LAN Progress

LAN Launches 2017 APM Framework Refresh and Prepares for Nationwide APM Progress Measurement Effort

The LAN is committed to conducting an annual assessment of the nation’s efforts to implement APMs. When the LAN was launched in March of 2015, developing and publishing the APM Framework was a critical first step for establishing a common nomenclature for payment reform and a structure for gauging progress. Since then, the Framework has supported national conversations and influenced action toward the shift to adopt APMs, and the 2016 progress tracking effort provides a foundation for measuring subsequent progress. To ensure that the APM Framework remains relevant and practical, it is important to revisit this landmark effort in light of the passage of MACRA legislation and the ensuing CMS regulations, evolving concepts of what constitutes an APM, and lessons learned both from implementation as well as the LAN’s 2016 progress tracking effort.

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.

Making the Business Case for Maternity APMs

The Maternity Multi-Stakeholder Action Collaborative (MAC) held its first virtual meeting on February 8 on the topic “Making the Business Case for Maternity APMs,” with MAC members from all stakeholder groups attending. Brooks Daverman, Director of Strategic Planning and Innovation at the Tennessee Division of Health Care Finance and Administration (TennCare), shared his state’s experiences related to the decision to pursue episode-based payment and the costs of designing and implementing the episodes.

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.

Payers Share Regional Successes & Challenges

Payer collaboration on data sharing/distribution and quality measure alignment is the focus of one of three participant-selected work tracks in the Primary Care Payer Action Collaborative (PAC), which the LAN launched late last year to accelerate payer efforts to develop systems and solutions for implementing sustainable multi-payer primary care APMs. Two other tracks within the PAC explore how payers can create a shared vision of regional success and operationalize Comprehensive Primary Care Plus (CPC+) Track 2 payments, a hybrid population-based and fee-for-service model with a performance-based incentive. CPC+ is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based, multi-payer payment reform and care delivery transformation.

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.

Harnessing Promising Practices in Data Sharing

Launched in December 2016, the Value-Based Payment Data Sharing and Requirements Initiative (DSRI) extends the efforts of the Population-Based Payment (PBP) Work Group by addressing the “how” question of data sharing and exchange. The PBP Work Group identified the most important elements of PBP models for which alignment across public and private payers could accelerate the adoption of these models nationally. The DSRI is focused on identifying strategies and practical approaches to enable effective sharing of clinical and claims data, which supports and accelerates the adoption of payment reform models most closely associated with categories 3 and 4 of the APM Framework.

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).

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.