Just Published: Principles for a Framework for Alternative Payment Models
- January 30, 2018
- Posted by: Health Care Payment Learning & Action Network
- Category: Blog
A new article describing the importance and utility of the Health Care Payment Learning and Action Network (LAN) APM Framework to measure the adoption of new payment models was recently published in the Journal of the American Medical Association. The article follows the release of the refreshed APM Framework White Paper earlier this year and highlights three major themes in the framework’s foundational principles:
- patient protections against perverse economic incentive
- health care professional protections against undue risk; and
- value-based goals for payment reform
The APM Framework White Paper refresh was developed by a multi-stakeholder Advisory Group led by the Chair of the initial APM Framework Work Group, Sam Nussbaum, M.D. (University of Southern California Shaeffer Center). It provides new and updated category definitions and clarifies foundational principles. Specifically, the refreshed Framework:
- clarifies relationships between Advanced APMs under MACRA and categories in the LAN APM Framework (see discussion of Category 3 and Appendix A);
- identifies opportunities for small, rural, and safety net providers to increase APM adoption (see Principles 3 and 6);
- includes a new framework sub-category for the growing sector of integrated finance and delivery organizations (see discussion of Category 4); and
- identifies opportunities to modify the APM Framework in ways that expedite and simplify the progress-tracking effort (see discussion of Category 2).
Incorporating these updates into the APM Framework helps ensure that the Framework remains a useful tool for measuring progress and executing strategies for payment reform. The refreshed APM Framework can be accessed by clicking here.
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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.
