The LAN has launched an effort focused on providing operational guidance for implementing successful Category 3 and 4 APMs (LAN’s Refreshed APM Framework). This work, titled a Roadmap for Driving High Performance in 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.

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 who were both more and less successful 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.

Early findings from the APM Roadmap project will be shared at this year’s LAN Summit on October 22, with goal of obtaining feedback from the field.  The final Roadmap for Driving High Performance in APMs will be released in early 2019.  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 (jsulkin@mitre.org).

APM FRAMEWORK
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


CLINICAL EPISODE PAYMENT MODEL
WHITE PAPERS
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

POPULATION-BASED
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.

 Maternity Care Resource Bank
Primary Care Payer Resource Bank


POPULATION-BASED PAYMENT MODEL
WHITE PAPERS
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

PRIMARY CARE PAYMENT MODEL
WHITE PAPERS
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
CMMI
David Kendrick, MD
Chief Executive Officer
MyHealth Access Network
JD Fischer
Senior Health Policy Analyst
Washington State Health Care Authority
Renee McLaughlin, MD
Senior Medical Officer, Cigna
Susan Frampton, Ph.D.
President
Planetree International
Angelo Sinopoli, MD
Vice President, Clinical Integration and Chief Medical Officer
Greenville Health System

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