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Participation Matters
How are health care payments shifting away from traditional fee-for-service arrangements toward alternative payment models (APMs)? Where does the nation stand in APM adoption in the commercial, Medicare Advantage, and Medicaid markets?
Having a common definition of alternative payment is critical to our ability to move forward together. When health plans report payments in alignment with the Health Care Payment Learning and Action Network (LAN) APM Framework, you gain an accurate understanding of your position in your markets.
The LAN is currently recruiting health plans to participate in the 2017 APM Measurement Effort. Grab a seat at the table as health plans across the country contribute to our understanding of progress in APM adoption. Your participation will inform and bolster our understanding of nationwide progress toward APMs, and thus give you a better idea of where you stand in relation to other health plans.
Where Do You Stand?
As reimbursements move away from traditional fee-for-service models toward the adoption of APMs, health plans want a consistent and standard way to measure APM adoption and understand trends. In exchange for your participation, the LAN will provide a benchmarking report based on the data received through the survey to help participants understand how they stack up in the market.
This report is contingent on the number of health plans participating in the effort; however, the LAN will provide benchmarking details to the level of granularity possible while still maintaining anonymity for contributing health plans. If enough health plans participate to ensure that the results in each market segment are nationally representative and anonymity can be preserved, it may be possible to provide benchmarking data by line of business.
How We Measure
For 2017, participating health plans will report total in- and out-of-network health care spending paid to providers through each of the APM Framework categories during 2016 or the most recent 12 months in the commercial, Medicaid and Medicare Advantage markets. The LAN works directly with participants to ensure a clear understanding of how to classify payments in the APM framework. This makes participation as simple and straightforward as possible.
Individual plan data will be kept strictly confidential. It will not be shared with other health plan participants or parties outside of the LAN data collection team. For reporting purposes, individual plan data will be aggregated with data from other health plans.
For more detailed information on the data collection methodology, click here.
How You Define APM
Individual plan data will be kept strictly confidential. It will not be shared with other health plan participants or parties outside of the LAN data collection team. For reporting purposes, individual plan data will be aggregated with data from other health plans.
For more detailed information on the data collection methodology, click here.
What is the Outcome?
The LAN’s first APM Measurement Effort in 2016, which included data on nearly 200 million Americans (67% of covered lives), revealed that 23% of payments made in 2015 were in APM categories 3 and 4.
The 2017 Measurement Effort will provide information on payments made in 2016, allowing for comparison over time and an indication of the movement toward APM adoption.
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Enabling Organizations | 
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.
