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Maternity Care Episode Resource Bank Now Available |
To accelerate the movement toward maternity episode payment models, the LAN operated the Maternity Multi-Stakeholder Action Collaborative (MAC) from December 2016 through September 2017. The MAC’s goal was to accelerate the adoption of maternity care alternative payment models (APMs) that improve outcomes and care experience for mothers and babies, and reduce the cost of care. The operating framework for this was the LAN’s Clinical Episode Payment (CEP) White Paper maternity recommendations. Over the past ten months, the MAC hosted nine virtual meetings where participants shared knowledge and expertise on topics related to design and implementation of maternity episodes, including making the business case, selecting and using quality measures, determining services and population, developing the episode budget, working with Medicaid Managed Care organizations, and others.
This resource bank provides a one-stop-shop for maternity care episode model resources including the LAN CEP white paper maternity recommendations, and MAC virtual meeting slides, e-books, and summaries. We encourage you to use this information and to keep the LAN informed of your work in designing and implementing maternity APMs. |
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LAN Summit Event Round-Up |
More than 600 health professionals, including providers, payers, purchasers, consumer and patient advocates, state agency and Medicaid representatives, federal agency representatives, and national policymakers gathered for the 2017 LAN Fall Summit held in Arlington, VA on October 30, 2017. The program included more than 20 breakout sessions over the course of the day, with nearly 100 speakers participating in panel discussions on practices that promise to help advance effective APMs across the country.
The opening plenary was delivered by Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS). During her address, Verma spoke of some of CMS’ top priorities, including patients over paperwork, meaningful measures, and new directions for the Center for Medicare & Medicaid Innovation (CMMI). The full transcript of her remarks are here. The keynote session featured Senator Bill Cassidy (R-Louisiana) and former Senate Majority Leader Tom Daschle, Founder and CEO of The Daschle Group. Daschle and Cassidy shared their thoughts and insights on the importance of value-based care, and ways that stakeholders can work together to accelerate payment reform. Select sessions from the LAN Summit are highlighted below, and presentations from all sessions are available for download on the LAN Summit website. You can also review #LANSummit on Twitter to see participants’ social media activity from the Summit. |
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Updated Performance Measurement for Alternative Payment Adoption |
The LAN Summit marked the announcement of the 2017 LAN APM Measurement Effort results, which reported the adoption of APMs in 2016 payments. Sam Nussbaum (University of Southern California, and former member of the LAN Guiding Committee) moderated the panel on the measurement effort, which included Scott Hewitt (United Healthcare), Nancy Wexler (Banner Health Network), Heather Leaphart (Priority Health), and Armando Del Toro (America’s Health Insurance Plans). Panelists shared perspectives on APM adoption from the commercial, Medicaid, and Medicare Advantage market segments, as well as from a trade association perspective.
The measurement surveys collected data from over 80 participants across fee-for-service Medicare, Medicare Advantage, Medicaid, and commercial health plans, accounting for nearly 245.4 million people, or 84% of the covered U.S. population, up from 67% in the 2015 measurement findings. The panel highlighted key results from the 2017 measurement effort, which sought to identify the percentage of health care payments that are tied to value (Categories 3 and 4 in the APM Framework) based on 2016 payments. Notably, 29% of total U.S. health care payments were tied to APMs in 2016, which is a 6 percentage point increase from 2015 measurement findings. These results are in line with the goals of the LAN to tie 30% of total U.S. health care payments to APMs by 2016 and 50% by 2018. Panelists also spoke about the importance of understanding the data, and how this information can be used to continue acceleration toward alternative payment. Following the LAN Summit, Mark McClellan discussed the report’s findings on the Hospital Finance Podcast. |
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Implementing Population-Based Payment in Rural Communities |
This panel discussion, moderated by Dianne Hasselman (National Association of Medicaid Directors), focused on the challenges rural providers face when implementing APMs, including specific issues rural providers encounter when delivering care. The session also covered the intersection between these challenges and the barriers to APM adoption, as well as opportunities to design APMs to better accommodate rural providers. The panel included Jon Griffin (Blue Cross Blue Shield of Montana), Maeve McClellan (National Rural Accountable Care Consortium), and Travis Broome (Aledade).
Panelists highlighted a number of unique challenges that rural health care providers face when caring for their patients. Most notable is the challenge of coordinating care across large geographies, and the access problems this creates for rural patients. Shortages of providers—particularly mental health specialists and primary care providers—also creates access challenges and limits patient choice. Panelists discussed how these rural challenges affect APM implementation. For example, rural providers often do not have enough staff to meet all of the reporting and administrative requirements associated with APMs. Despite these challenges, panelists maintained that APMs present an opportunity to improve care delivery in rural areas. |
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Encouraging Physician-Focused Innovation through PTAC |
In 2015, Medicare Access CHIP Reauthorization Act (MACRA) established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to evaluate physician-focused payment models proposed by individuals or stakeholder groups. In this panel session, attendees had an opportunity to learn more about the process and proposal evaluation criteria directly from PTAC members. Elizabeth Mitchell (Network for Regional Healthcare Improvement and PTAC member) moderated the panel, which included fellow PTAC members Len Nichols (George Mason University) and Kavita Patel (Brookings Institution), as well as Frank Opelka (American College of Surgeons), whose specialty care APM was recommended by the PTAC for implementation.
Panelists reviewed PTAC’s legislative mandate to provide non-binding recommendations to CMS on models it should consider implementing as advanced APMs under MACRA. The session also covered PTAC evaluation criteria for proposed APMs, including how well a proposed payment methodology supports high-value approaches to care delivery that are not adequately incentivized in other payment arrangements. The PTAC member panelists emphasized the collaborative relationship between PTAC and CMMI, noting that PTAC exists to support CMMI, and that they are working together to minimize unnecessary complexity with new models. |
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Integrating Physical and Behavioral Care |
Speakers across many sessions highlighted the need for more integration across care providers to increase value and quality of care. These concerns were discussed in detail in the session focused on ways to improve the critical interface between physical and behavioral care in order to improve patient outcomes. A panel of experts, including Greg Bowman (Anthem), Kate Neuhausen (Virginia Department of Medical Assistance), Brie Reimann (SAMHS-HRSA), Mishka Terplan (Virginia Commonwealth University), and Sowmya Viswanathan (Dartmouth Hitchcock Health), discussed their experiences with improving outcomes for patients with both clinical and behavioral health needs through integrated health care delivery models.
These models provide a continuum of care that includes managing multiple physical conditions, coordinating medications, providing mental health care and addiction recovery treatment services, and offering social services. Panelists discussed the challenges they encountered implementing these integrative models and how challenges were addressed, as well as success stories. The session highlighted that a culture of collaboration between physical- and behavioral-care providers is essential to providing comprehensive treatment. Panelists also discussed approaches for creating such a culture through co-located provider teams which help reduce silos and improve care coordination across multiple providers. |
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Supporting Provider Performance Alternative Payment Models |
Health care business models should align the interests of doctors, society, and patients. Although all providers, payers, and patients benefit from reducing the total cost of care and increasing the quality of care, some current business models do not incentivize this. This session featured expert panelists Farzad Mostashari (Aledade), Jim Walleshauser (Independent Health), David Pawlowski (High Gate Medical Group), and Craig Sammitt (Anthem), who discussed strategies for developing business models that would encourage the practices required to successfully deliver care within an APM.
Panelists highlighted how innovative information technology tools are being used to expand the breadth and depth of the impact of electronic health records (EHRs) on care delivery. Such tools and processes will likely lead to increases in efficiency and improve resource allocation. Value-based business models involve analytics tools that collect data on quality of care and work processes build on evidenced-based decision making. Panelists noted the potential for EHRs, when coupled with the effective use of these analytics, to enable value-based health care and reduce the total cost of care. The conversation closed with panelists emphasizing that the use of value-based business models is not a payer-only enterprise and encouraging payers and providers to work together to implement them. |
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Paying for Prescription Drugs with Value in Mind |
After a day of compelling sessions that addressed numerous challenges and opportunities faced by the health care community in its movement toward APMs, one closing session focused on the emerging issue of value-based contracting for prescription drugs.
Moderated by LAN Guiding Committee co-chair Mark McClellan, the “Value-based Purchasing for Prescription Drugs” session elicited a thoughtful and timely discussion with professionals from various stakeholder types, including drug manufacturing, drug distribution, and patient/consumer stakeholder groups. Christina Ritter (Patient Care Models Group, CMMI), Tamar Thompson (Brystol Myers Squibb), Leigh Anne Leas (Novartis), Barbara Henry (Harvard Pilgrim Health Care), and Rebecca Kirch (National Patient Advocate Foundation) contributed their diverse perspectives to the session as panelists. The panelists examined a variety of key issues aimed at building and improving value in drug pricing. They discussed the need for data collection around outcomes to ensure that money is spent on drugs that work, and are equally critical. They also discussed the need to establish consensus around the definition of a drug “failure,” and industry-related challenges, such as physician accountability in prescribing effective drugs, the need for improvements in EHR use and interoperability, and the need to seek a balance between value and cost, while acknowledging the reality that not all products can be evaluated using identical criteria. |
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