December 20, 2017 – eNewsletter

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.

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.

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.

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.

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.

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.

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.