2021 Q3 Newsletter | September 28, 2021
2021 LAN Summit
Announcing the 2021 LAN Summit! The Summit will take place December 15 and 16, 2021, from 1-4pm ET and will be held virtually.
Don’t miss this opportunity to learn about and discuss health equity and alternative payment model adoption with leading voices in healthcare innovation. The LAN also will release 2019 and 2020 APM Measurement Effort results.
Save the Date! Registration coming soon.
Keep checking your e-mail and follow the LAN on Twitter and LinkedIn for more information about this year’s Summit as it becomes available.
HEAT Welcomes Two New Members to the Team
Welcome to the LAN, Dr. Dora Hughes!
Dr. Hughes is joining the LAN’s Care Transformation Forum (CTF) as well as the Health Equity Advisory Team (HEAT). Dr. Hughes brings a wealth of experience, knowledge, and innovative ideas to these roles as she works with her colleagues within the LAN to enable real and lasting change for the nation’s healthcare system. Dr. Hughes recently joined the Centers for Medicare & Medicaid Services (CMS) leadership team and will serve as a senior advisor to the Center for Medicare & Medicaid Innovation (the Innovation Center) where she will lead health equity initiatives, provide clinical leadership and input on models, and serve as the Innovation Center’s primary liaison with medical and clinical stakeholders.
Prior to joining CMS, Dr. Hughes was an associate research professor in health policy and management at the Milken Institute School of Public Health at The George Washington University (GWU). Her work focused on the intersection of clinical and community health, social determinants of health, health equity, as well as healthcare quality and workforce, including working with the CMS Innovation Center staff on the Accountable Health Communities model.
Prior to her tenure at GWU, Dr. Hughes was a senior policy advisor at Sidley Austin, where she provided expertise on regulatory and legislative matters in the life science industry.
Welcome to the HEAT, Jean Moody-Williams!
LAN is proud to announce that Ms. Jean Moody-Williams is joining the HEAT. Ms. Moody-Williams, RN, MPP, is the Deputy Director of CMS’s Center for Clinical Standards and Quality where she leads policy activities for Quality Improvement Programs (QIOs), End Stage Renal Disease Networks, Survey and Certification, Quality Measurement and Health Assessment, Clinical Standards, Coverage and Analysis, Quality Innovations Models and many of the agency’s value based purchasing and public reporting programs for hospitals, physicians, and ambulatory settings.
Prior to her current role, Ms. Moody-Williams was the group director for the CMS Quality Improvement Group (QIG) and provided oversight for the nation’s QIOs and the End Stage Renal Disease Quality Networks, which provide a national infrastructure to support technical assistance, learning and action networks, and a variety of value and quality improvement efforts across the entire continuum of care. She also served as the director of quality for CMS Medicaid Programs.
The LAN recently launched a new podcast series, Spotlight on Action, highlighting LAN stakeholders’ work to advance health equity, knockdown barriers to access, implement alternative payment models, and improve the healthcare system for payers, providers, purchasers, and patients alike. The podcast offers listeners in-depth conversations with leaders of the healthcare transformation movement across the country.
Check out the first two episodes below. And keep checking back for upcoming episodes featuring the LAN Executive Forum Co-chairs!
Frederick Isasi, Families USA
Families USA is one of the nation’s leading nonpartisan, nonprofit healthcare advocacy organizations. Its goal, which aligns with those of the LAN, is to ensure that all people receive high quality, affordable person-centered care. Executive Director of Families USA, Frederick Isasi, is a national thought leader on healthcare reform and a sought-after subject matter expert on innovative ways to drive value and equity in the healthcare system. For the inaugural episode of Spotlight on Action, Mr. Isasi was interviewed by Aparna Higgins, senior advisor to the LAN and a senior policy fellow at the Duke Margolis Center for Health Policy.
The conversation between Mr. Isasi and Ms. Higgins flowed easily between the issues of healthcare value, health, and the consumer experience. It focused on real world examples of how health transformation can be achieved as well as the challenges and barriers hindering transformation to a more equitable healthcare system for all.
When discussing what the healthcare system should be, rather than how it currently operates, Mr. Isasi stated that healthcare transformation should be about “reorienting the system all the way towards health, not just simply units of healthcare.” He explained that healthcare must be affordable so it does not create economic instability for families, and they can thrive.
The conversation also focused on specific aspects of needed health reforms, especially as they pertain to the LAN’s objectives. Ms. Higgins mentioned how the HEAT correlates with the work Mr. Isasi and Families USA is currently doing, stating, “the LAN recently established the Health Equity Advisory Team to help identify and prioritize opportunities to advance health equity through APMs, influence design principles and inform LAN priorities and initiatives.” She pointed out that like Families USA, the LAN’s goal is person-centered care that is more accessible, drives better patient outcomes, and reduces disparities.
Listen to the full Spotlight on Action interview or read the Q&A on the website. We encourage you to continue to check our website as we are planning a full calendar of Spotlight interviews that profile the work of the LAN and its members.
“When you are trying to redesign a system, we have to put the end user into the center of the design enterprise.”
—Frederick Isasi, Families USA
Dr. Andrea Gelzer & Karen Dale, AmeriHealth Caritas
AmeriHealth Caritas is one of the nation’s leading Medicaid managed care organizations that focuses on low-income and chronically ill populations. It is at the forefront of identifying ways to make healthcare more open and accessible to all people—regardless of race, gender, income, or health status. Many members of the population that the organization serves face barriers to accessing care—from existing disparities in the healthcare system to grappling with social determinants of health, including environment, housing, and transportation.
During the interview, both Dr. Gelzer, senior vice president and chief medical officer for AmeriHealth Caritas and a member of the LAN’s Care Transformation Forum, and Ms. Karen Dale, the chief diversity, equity and inclusion officer, as well as the market president of AmeriHealth Caritas’ Medicaid managed care organization in Washington, DC, and co-chair of the LAN’s Health Equity Advisory Team (HEAT), shared their insights and opinions on how their organization is responding to issues of equity and access while promoting value-based payment initiatives to improve outcomes.
Dr. Gelzer pointed out that while AmeriHealth has made strides in implementing APMs—evidenced by the nearly 90 percent of low-income and chronically ill populations now receiving care from a provider participating in an APM—there are still significant structural barriers that need to be addressed.
“Provider interest in downside risk for a Medicaid population continues to be a significant hurdle we have yet to overcome today,” explained Dr. Gelzer. “We’re leveraging our…programs to improve social determinants of health, health equity, and access to healthcare in the communities we serve. We’ve incorporated incentives for reporting of Z codes for social determinants of health into our value-based programs and really continue to see an increase in provider reporting.”
Ms. Dale highlighted AmeriHealth Caritas’ strategy to reach and encourage their patient population to take control of their health and to be part of the solution to transform the healthcare system to better work for them.
Ms. Dale, additionally, provided insight on how to transform the nation’s healthcare system to ensure that it is accessible to all and based on value and outcomes rather than service.
“We must meet them where they are, not where we would wish to begin,” Ms. Dale remarked. “Part of the transformation in terms of our healthcare delivery system, where alternative payment methods come in, is giving that level of flexibility, support, and engagement with providers…to ensure people are getting what they need.”
Ms. Dale offered her thoughts on how the healthcare system can provide better maternal health to women of color by bundling payment options, supporting of nurse practitioners, connecting obstetricians with community-based organizations to allowing more time for screening, and peer support groups encouraging good health. She explained that creating an additional delivery system with wraparound services can improve health outcomes.
The example of maternal care for women of color is just one of the many illuminating topics that was covered in this issue of Spotlight on Action. To hear the full conversation or read the interview transcript, please visit the Spotlight on Action website.
“The Holy Grail [of APMs] is multi-payer alignment.” –Dr. Andrea Gelzer
“Health equity can’t wait. Alternative payment models offer a powerful lever to create a shift to whole-person care and improved outcomes by creating flexibility in reimbursement that supports addressing medical and social factors.” –Karen Dale
LAN in the News
Chiquita Brooks-LaSure, Liz Fowler, Meena Seshamani, and Daniel Tsai
Read: Health Affairs’ blog: Innovation At The Centers For Medicare And Medicaid Services: A Vision For The Next 10 Years
• Ms. Brooks-LaSure, Ms. Fowler, Ms. Seshamani, and Mr. Tsai explain, “The Innovation Center’s vision for the next decade is a health system that achieves equitable outcomes through high quality, affordable, person-centered care. In order to deliver on the promise of putting people at the center of their care, we need a health system that meets people where they are, keeps people healthy and independent, and coordinates care seamlessly and holistically across settings.”
Executive Forum Member Bruce D. Broussard
Read: Humana’s 2020 Corporate Social Responsibility Report
• Mr. Broussard notes how the challenges of COVID-19, “sharpened our commitment to human care and to efforts that advance health equity, simplify healthcare, and enable integrated experiences for our customers.”
CEO Forum Member Jaewon Ryu
Read: HealthLeaders CEO Exchange Roundtable: Lasting Impact
• Mr. Ryu joined two of his fellow healthcare executives to discuss for an in-depth discussion on the current state of the healthcare world and the fundamental system shifts that have occurred.
Organization: Intermountain Healthcare
Listen: AHA’s Advancing Health Podcast “Community Health Improvement Week 2021: Reflections, Lessons and Inspirations from an Extraordinary Year”
• Nancy Myers, American Hospital Association (AHA) vice president of leadership and system innovation, talks with Mikelle Moore, senior vice president and chief community health officer at Salt Lake City, Utah-based Intermountain Healthcare, about community health improvement during and after the COVID-19 pandemic.
Executive Forum Co-Chairs Dr. Mark McClellan, Dr. Marc Harrison, Emily Brower, and Dr. William Shrank
Watch: The September 20-23, 2021 Co-Located Value-Based Summit
• Members of the LAN’s CEO Forum and Care Transformation Forum were among the conference faculty. Marc Harrison presented the private sector keynote during the opening plenary session while Dr. Mark McClellan presented the private sector keynote during the closing plenary session.
CEO Forum Member Karen Lynch
Read: Bloomberg: CVS Promises More Health Care, Less Candy Under New CEO
• “We are moving toward being a much more consumer-centric health-services, health-solutions company meeting the needs of consumers where they want to be met.”
Read: Forbes: Forbes 50 over 50 Women Spotlight
• Ms. Lynch is among the four female healthcare leaders featured on the list, along with Biochemist and Senior VP at BioNTech Katalin Karikó, Walgreens CEO Rosalind Brewer, and American Red Cross CEO Gail McGovern.
An American healthcare system that pays for value to the benefit of our patients and communities.
To accelerate the shift to value-based care in order to achieve better outcomes at lower cost.
Our Goal Statement
Accelerate the percentage of US healthcare payments tied to quality and value in each market segment through the adoption of two-sided risk alternative payment models.