Just Released: Final White Paper on Clinical Episode Payment Models
- August 1, 2016
- Posted by: Health Care Payment Learning & Action Network
- Categories: LAN Update, Work Product Releases
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| Today, after months of collaboration and analysis and the incorporation of public input, the LAN is pleased to announce the release of the final white paper on Clinical Episode Payment (CEP) models.
The paper, developed by the Clinical Episode Payment Work Group chaired by Guiding Committee member Lewis Sandy, provides guidance for the design and implementation of CEP models, specifically focusing on elective joint replacement, maternity care, and coronary artery disease. |
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| Final White Paper on CEP Models |
| The LAN’s white paper, entitled, Accelerating and Aligning Clinical Episode Payment Models, provides a high-level roadmap for providers, health plans, purchasers, and states interested in implementing CEP models with recommendations on how to design these models while leaving enough flexibility to allow for tailored implementation in local markets. The paper addresses how CEP models can position patients and consumers – their clinical needs, values, and preferences – at the center of the health care system.
The paper includes recommendations based on analysis of current episode model initiatives and extensive deliberations of Work Group members . The paper recommends that procedure-based episodes begin at a point pre-procedure, to include the cost of pre-conditioning diagnostics and services. Another recommendation relates to setting the episode population in a way that is broad enough to ensure that the highest-need patients are included and will receive the highest quality, appropriate care. The paper also provides critical thinking about setting the episode price, setting the payment flow, and appropriately adjusting for risk. In addition to the recommendations themselves, the paper provides detailed information on current initiatives, organized by how they address the ten design elements of the CEP roadmap. Ultimately, the paper lays a foundation for the LAN to move seamlessly into its next phase of work of assembling a multi-stakeholder action collaborative to implement these recommendations, starting with maternity care. If you are interested in participating in this next phase of LAN work, please contact Tanya Alteras (talteras@mitre.org). |
 read the paper |
Health Plans | 
Policy Makers
Community-Based Organizations
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.
