March 18, 2018 – eNewsletter

The 2018 Health Care Payment Learning and Action Network (LAN) Fall Summit is scheduled for Monday, October 22, 2018, at the Sheraton Tysons Hotel in Tysons, Virginia. The 2018 Summit will continue to build on the momentum of the LAN by bringing together stakeholders from across the health care system to transform payment in a way that emphasizes quality over volume. The Summit will feature leaders and innovators in health care as speakers in plenary and break-out sessions throughout the day, including the following:

• Industry leaders discussing an array of innovations in payment reform, touching on implementation methods and lessons learned;
• Federal and state health care purchasers describing how they are addressing the current and future health care delivery challenges via new payment models that put the patient first; and
• LAN Summit attendees collaborating in facilitated workshops designed for specific stakeholder groups focusing on vital areas of interest – and challenges — surrounding design and implementation of APMs.

On February 20, 2018, the Journal of the American Medical Association published an article authored by LAN contributors titled Principles for a Framework for Alternative Payment Models. This article highlights the LAN’s APM Framework that was refreshed in 2017 and outlines three major themes in the framework’s foundational principles:

• Patient protections against updated economic incentives for providers;
• Health care professional protections against undue risk; and
• Value-based goals for payment reform

The APM Framework White Paper was initially developed in January 2016 and updated in July 2017 by a multi-stakeholder Advisory Group led by Sam Nussbaum, M.D. (University of Southern California Shaeffer Center). The refreshed paper provides updates to categories, clarifies payment reform goals, and identifies ways to increase APM adoption.

The APM Framework has been used to guide an annual measurement effort to assess the progress of APM adoption against the LAN’s goal of having 50% of all health care payments in the U.S. linked to quality and value through APMs by 2018. The most recent measurement effort, conducted from June to August 2017, surveyed and collected data from over 80 plans and payers, accounting for nearly 245.4 million Americans, or 84% of the covered U.S. population, up from 67% in the previous year. The latest report shows progress with 29% of total U.S. health care payments tied to alternative payment models (APMs) in 2016 compared to 23% in 2015, a 6 percentage point increase in the adoption of APMs.

The LAN’s Primary Care Payer Action Collaborative (PAC) continues to support commercial and public payers participating in Comprehensive Primary Care Plus (CPC+) by bringing payers together to share learnings and solutions as they implement alternative to fee-for-service payments to physician practices in Track 2 of the model. A Centers for Medicare & Medicaid Services initiative, CPC+ is a regionally based, multi-payer advanced primary care model operating in 18 regions.

The PAC’s current series of interactive webinars kicked off in February with a session on risk adjustment and financial reconciliation. During this session, Independent Health provided an overview of its Primary Value Model, which launched in January 2018 with approximately 130 practices. It aims to transition eligible practices from fee-for-service (FFS) to value based reimbursement and reward primary care providers for providing value. The second session in the series addressed specific aspects of constructing an alternative to FFS payment, during which Capital District Physicians’ Health Plan (CDPHP) provided an overview of its Enhanced Primary Care model, a patient-centered medical home (PCMH) model that offers increased value for members and financial rewards for physicians. As part of a deeper dive on operations, the PAC’s other virtual sessions in 2018 include designing payment to support advanced team-based care at the practice site, Medicaid-specific alignment opportunities, and reconfiguring claims processing systems to enable alternative payments. You can access summaries, slides, and other materials from these and earlier PAC activities on the public PAC Portal as they become available.

For questions about the PAC, please contact Jennifer Sulkin, PAC staff lead.

The LAN will soon be releasing the Maternity Episode Care Roadmap for State Action. This product highlights the ways in which two states – Ohio and Tennessee – established their maternity episode payment models for their Medicaid populations. Both states received State Innovation Model (SIM) grant funding, which was used to design and launch their episode models. This report also includes information about the considerations that drove various high-level decision points. The road map is a part of the Maternity Episode Payment Model Online Resource Bank, which includes issue briefs, infographics, and resources from the Maternity Care Action Collaborative (MAC) meetings that were convened by the LAN last year.