APM Roadmap Initiative

The LAN has launched an effort focused on providing operational guidance for implementing successful Category 3 and 4 Alternative Payment Models (LAN’s Refreshed APM Framework). This work, titled a Roadmap for Driving High Performance in Alternative Payment Models (APMs), will be an implementation guide that payers can use to work with providers, purchasers, consumers, and others to accelerate the creation and adoption of high-performing APMs by diffusing criteria that can be used to evaluate the success of APMs and sharing best practices from APMs that drive high performance. Click on an icon in the timeline to see more information.

Roadmap Launch Webinar
April 3 at 11:30 a.m. ET

This webinar will feature LAN Guiding Committee co-chairs Drs. Mark McClellan from Duke University and Mark Smith from the University of California at Berkeley and the University of California at San Francisco. Dr. Angelo Sinopoli from Prisma Health and Alicia Berkemeyer from Arkansas Blue Cross Blue Shield will be in attendance with Roadmap Work Group chair Tom Buckingham from Select Medical moderating the discussion along with the co-chairs. The panel will share their thoughts on APM design and implementation, with a focus on how the Roadmap tool can help identify promising practices and strategies to help payers address challenges.

Read the APM Roadmap Initiative Overview.
Feel free to share and as always we welcome your feedback and questions!

Exploring APM Success Factors: Insights from a Focused Review.
Download a copy to read about the progress of the APM Roadmap Initiative.

Roadmap Overview

The Roadmap for Driving High Performance in APMs is being developed by a multi-stakeholder Work Group comprised of experts with extensive experience in the design and implementation of APMs. The goal of the “APM Roadmap” initiative is to promote the adoption of high-performing value-based payment models by identifying APMs that meet meaningful goals related to cost and quality, ascertaining their most promising practices, and developing a guide for payers to create and implement high-performing APMs. Guided by a set of criteria linked to high performance in cost and quality measures identified by the Work Group, the LAN will reach out to successful APMs in the field to learn about best practices, how payers and providers within the models overcame challenges, and other contextual factors influencing success.

The APM Roadmap also aims to capture lessons learned from a spectrum of provider participants (i.e., those with differing levels of experience within a specific APM). Both lessons learned and identified best practices will be used to capture the work that needs to be done to operationalize a successful APM.

A group of payer representatives from national and regional health plans has been convened. This group, referred to as the Roadmap Implementation Group (the “RIG”), will contribute to the Roadmap by providing details from practical implementation experience and content that can be applied to the Roadmap. These payers will serve as a pilot group and will share information on APMs that meet the Work Group’s success criteria, provide perspectives that led to successful APM implementation, and establish connections to providers who are willing to discuss best practices and lessons learned.

The LAN website will highlight the Working Group’s milestones in the coming months, so stay tuned!

For questions about the APM Roadmap Initiative, please contact Jennifer Sulkin (apmroadmap@rippleeffect.com).

APM Roadmap Development Approach

The APM Roadmap initiative is collecting information from a diverse set of inputs to capture best practices of successful APMs and provider participants. These information sources and ways the information was and will be used are illustrated below in our development approach graphic. Click an area below and find out more!

APM Development Process

APM Development Process
APM Roadmap Work Group and LAN Guiding Committee Members: Background Research: Roadmap Implementation Group (RIG): Interviews with RIG Payers and their Participating Providers:

APM Roadmap Work Group and LAN Guiding Committee Members:

Provided strategic guidance on the structure of the work, and critical information and insights.

Background Research:

Examined a targeted selection of peer-reviewed and gray literature, and interviewed stakeholders, to identify best practices and challenges associated with APM design and implementation. This step was also used to inform the primary data collection from health plans and providers.

Roadmap Implementation Group (RIG):

Served as the pilot group and submitted detailed performance data and descriptive information about high-performing APMs.

Interviews with RIG Payers and their Participating Providers:

Conducted design and implementation to identify best practices and challenges for implementation on both sides of the payer/provider relationship.

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.

APM Framework
Journal of American Medical Association Article

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.

Maternity Care
 Cardiac Care
 Elective Joint Replacement

Online resource banks which provide a one-stop-shop for all the information and resources needed to facilitate implementation for certain specialty models.

 Maternity Care Resource Bank
Primary Care Payer Resource Bank

These white papers four priority issues that are foundational for the success of population-based payment models.

 Patient Attribution
 Financial Benchmarking
Data Sharing
Performance Measurement

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.

Primary Care Payment Model

Thomas Buckingham, BSN, MBA Chair
Executive Vice President
Select Medical
Steve Hussey
Senior Vice President, Compensation & Benefits
Western & Southern Financial Group
Craig Brammer
Chief Executive Officer
The Health Collaborative
Andrea Gelzer, MD
Senior Vice President & Corporate Chief Medical Officer
Amerihealth Caritas
Steve Farmer, MD
Senior Advisor and Medical Officer
David Kendrick, MD
Chief Executive Officer
MyHealth Access Network
JD Fischer
Senior Health Policy Analyst
Washington State Health Care Authority
Renee McLaughlin, MD
National Medical Director, Value-based Relationships, Cigna
Susan Frampton, Ph.D.
Planetree International
Angelo Sinopoli, MD
Chief Clinical Officer, Prisma Health
President, CEO & Founder, Care Coordination Institute