In laying the foundation for this work, the HCP-LAN team conducted background research to gain insight into successful APM implementation. This exploratory research included a targeted literature review, as well as discussions with 25 stakeholders who have a deep understanding of, and experience in, APM implementation. A primary goal was to obtain information about potential correlates of successful APMs, including both characteristics of APMs (such as size or level of experience) as well as actions taken by either payers or providers in the design and/or implementation of an APM to improve outcomes . In addition, the team explored common challenges encountered by APM implementers and potential solutions for overcoming barriers.
Based on this research, the Roadmap is expected to explore best practices in the following areas:
- The need for strong, committed health plan and provider leaders, who build trust with each other and with front-line practitioners.
- Determining level of flexibility in the risk framework and payment approaches to enhance population health infrastructure.
- The adoption of new technologies and data sharing approaches, as well as how strategies for addressing technical limitations, lack of interoperability, and workforce constraints.
- The role of care coordination, including strategies to impact high-need or high-cost patients.
- The importance of engaging physicians as partners in value-based transformation, including involving them in APM design and implementation.
- Best practices for patient centeredness, particularly the involvement of patients and families in APM design, implementation, and evaluation.
- Key strategies and considerations for multi-payer collaborations, including observations about consensus-building, anti-trust concerns, technology gaps, and local market and policy environments.
- How purchasers are working directly with providers to build high-value networks through Centers of Excellence (COE), using benefit design to incentivize their utilization.
These documents describe an alternative payment model (APM) framework that can be used to track progress on payment reform along a path that supports person-centered care.
CLINICAL EPISODE PAYMENT MODEL
These white papers provide high-level recommendations for designing clinical episode payment models. A clinical episode payment is a bundled payment for a set of services that occur over time and across settings.
AND SPECIALTY MODELS
Online resource banks which provide a one-stop-shop for all the information and resources needed to facilitate implementation for certain specialty models.
POPULATION-BASED PAYMENT MODEL
These white papers four priority issues that are foundational for the success of population-based payment models.
PRIMARY CARE PAYMENT MODEL
This paper offers principles and recommendations for implementing PCPMs that can help overcome the barriers to effective primary care tied to traditional fee-for-service payments based on the volume of services provided rather than the quality and value of care.
|Thomas Buckingham, BSN, MBA Chair|
Executive Vice President
Senior Vice President, Compensation & Benefits
Western & Southern Financial Group
Chief Executive Officer
The Health Collaborative
|Andrea Gelzer, MD
Senior Vice President & Corporate Chief Medical Officer
|Steve Farmer, MD|
Senior Advisor and Medical Officer
|David Kendrick, MD
Chief Executive Officer
MyHealth Access Network
Senior Health Policy Analyst
Washington State Health Care Authority
|Renee McLaughlin, MD
Senior Medical Officer, Cigna
|Susan Frampton, Ph.D.|
|Angelo Sinopoli, MD
Chief Clinical Officer, Prisma Health
President, CEO & Founder, Care Coordination Institute