Committed Partners - Health Care Payment Learning & Action Network

Academy of Nutrition and Dietetics

Commitment Statement:

The Academy of Nutrition and Dietetics, representing more than 100,000 registered dietitian nutritionists (RDNs), nutrition and dietetic technicians, registered (NDTRs), and advanced-degree nutritionists, is the largest association of food and nutrition professionals in the United States and is committed to improving health through food and nutrition across the life cycle.The Academy commits to accelerating the adoption of Alternative Payment Models by preparing and engaging a workforce that will provide patient-centered cost-effective care and add value for all stakeholders engaged in an Alternative Payment Model environment. The Academy will:

Leverage the LAN and its partners and industry resources to develop customized education for RDNs including toolkits, webinars, face-to-face learning, the Journal of the Academy of Nutrition and Dietetics, and web-based content to increase the knowledge of seasoned professionals and those in training who will add value in organizations adopting Category 3 and 4 APMs.
Offer “technical assistance” to LAN partners testing Clinical Episode or Population-Based Payments where stakeholders want to include evidence-based nutrition care in the design.
Share its Patient-Centered Nutrition Services framework with LAN participants seeking to estimate the total cost of care throughout the continuum of care in chronic disease prevention and management.

Website:

Academy of Nutrition and Dietetics

ACAP

Accountable Care Learning Collaborative

Advisory Board

Aetna

Alliance of Community Health Plans

Alliance of Wound Care Stakeholders

AltaMed Health Services

American Academy of Family Physicians

American Association of Hip and Knee Surgeons

American Association of Retired Persons

American Cancer Society

American College of Cardiology

American College of Physicians

American Heart Association

American Physical Therapy Association (APTA)

Commitment Statement:

APTA supports the transition to value-based payment models and is committed to ensuring the success and viability of the physical therapy profession as the health care system evolves. We strongly believe that the success of APMs in improving the quality of care and decreasing costs will depend on the collective efforts of all health care providers throughout the health care spectrum, including physical therapists in private practice, home health agencies, rehabilitation agencies, inpatient rehabilitation facilities, skilled nursing facilities, and other providers.

APTA is exploring a variety of opportunities for partnership regarding the inclusion of physical therapy in APMs:

Other provider groups with a similar interest in improving patient outcomes with the use of physical therapy.
Existing APMs (including Advanced APMs), in which physical therapy can have an impact on outcomes, quality, and cost
Health plans (Medicare, Medicare Advantage plans, and commercial) who are interested in innovative payment models in which physical therapy can make an impact

Actions:

Test APMs with collaborative partners to determine the impact of physical therapy services on outcomes, quality, and cost
Provide educational programming related to APMs and payment reform at conferences and external stakeholder events
Promote physical therapist participation in APMs

Activities:

Educate members/stakeholders/consumers on the importance of APM adoption
Provide written and technical resources and assistance in support of APM adoption
Spread best practices around APM adoption
As applicable, serve as a “convener” to support and promote APM adoption
Influence policy makers regarding the merits of APM adoption
Invite LAN experts to speak at meetings/events
Share LAN materials and information
Encourage partners and stakeholders to provide input into LAN activities
Provide leadership on and participation in LAN committees and work groups

Website:

American Physical Therapy Association (APTA)

AmeriHealth Caritas

Anthem Blue Cross Blue Shield

Aria Health

Arizona Health Care Cost Containment System

Arkansas Blue Cross and Blue Shield

Arkansas Department of Human Services

Asian & Pacific Islander American Health Forum

Ascension

Atrius Health

Avamere Health Services

Aver Inc.

Blue Cross and Blue Shield of Kansas City

Blue Cross and Blue Shield of Louisiana

Blue Cross Blue Shield of Massachusetts

Blue Shield of California

Commitment Statement:

Blue Shield of California supports the U.S. Department of Health and Human Services’ efforts to improve the cost and quality of health care in America, and is proud to participate in the Health Care Payment Learning and Action Network launched recently by President Obama and Secretary Burwell. As part of our participation, Blue Shield has committed to having 40 percent of our healthcare spending in value-based payment models by 2016, and 60 percent by 2018.

The Network’s goal to advance payment models that reward high-value and high-quality care is aligned with our mission and consistent with our strategy. Our efforts started more than 30 years ago, with risk-based compensation models, pay-for-performance programs and, more recently, bundled and global payment models.

In 2010, Blue Shield launched our first Accountable Care Organization (ACO), a collaboration with providers that has delivered impressive results by improving coordination of care and reducing costs. The program is a strategic priority for Blue Shield in order to help stem the rising cost of health care while improving quality and delivering a better patient experience. Our model is predicated on a robust framework of aligned financial incentives and shared governance with our hospital and physician partners, and a commitment to the principle that only the best clinical processes can yield meaningful benefits over time. The program has thus far delivered savings to our customers in excess of $313 million and resulted in an aggregate cost of health care increase of about 3 percent annually, roughly half the increase of our non-ACO business.

Since 2010, we have consistently expanded our ACO program. We now have 22 ACOs operating throughout the state, including the San Francisco Bay area, the San Joaquin Valley, Los Angeles, Orange County and San Diego, serving 263,000 Californians. In 2014, we launched our first Medicare Advantage ACOs and in 2015 we are offering a PPO ACO.
We commend President Obama, Secretary Burwell, and the other health plans and provider groups that have made commitments to join the Network and help transform the healthcare delivery system. Only by working together can we accomplish these critical goals.

Website:

Blue Shield of California

Press Release:

Statement on HHS Health Care Payment Learning and Action Network by Paul Markovich, Blue Shield of California CEO

Bluestone Physician Services

Buying Value

Cambia Health Solutions

CAPG

Commitment Statement:

CAPG’s goal is for all CAPG members to have at least 90% of their Medicare (Original and Medicare Advantage) population in capitated payment arrangements by 2018.

CAPG VALUE GOALS
CAPG and its members are committed to advancing alternative payment models that include the following defining features:
(1) prospective, capitated payment to a multispecialty physician group;
(2) physician group provides care for a defined population of patients;
(3) medical group assumes responsibility for medical care, quality, clinical performance measurement, and accountability for administrative and financial performance.
CAPG’s goal is for all CAPG members to have at least 90% of their Medicare (Original and Medicare Advantage) population in capitated payment arrangements by 2018.

LEADERSHIP IN PROLIFERATING THE MODEL ACROSS THE COUNTRY
More than 50% of CAPG’s members are already participating in the above model to the fullest extent possible for their organizations. Other CAPG members have some experience with capitated payment in Medicare Advantage and are pursuing other types of alternative payment models, such as accountable care organizations, with their Original Medicare populations.
CAPG is committed to supporting its members’ achievement of this goal through its educational and advocacy programs.

CAPG’S COMMITMENT TO EDUCATION
CAPG will continue to educate medical groups about best practices via the Standards of Excellence™ Survey — a blueprint for the development of the clinical and financial attributes necessary to be successful in capitated models.

CAPG will continue to build programming into our annual conferences, regular committee meetings, and Capitol Hill briefings that prepares physician groups to accept clinical and financial risk in the future.

CAPG ADVOCACY
CAPG will work with likeminded organizations in Washington, D.C. to advance the policies necessary to build capitated payment opportunities in Original Medicare.
CAPG will advocate protecting and strengthening capitated delivery models where they are flourishing today, including in the Medicare Advantage program.
CAPG will advocate improving and expanding existing alternative payment models to set a foundation for organizations that want to take capitation in the future.
CAPG will continue to advocate for new models that allow physician organizations to test capitated payments in Original Medicare. As an example, CAPG has developed the Third Option, a new delivery model that uses a capitated payment model to foster high quality coordinated care for seniors.

Website:

CAPG

Publications:

CAPG Guide to Alternative Payment Models

Care Coordination Systems

Care Oregon

The Carolinas Center for Medical Excellence

Center for Health Innovation and Implementation Science

Center to Advance Palliative Care (CAPC) at Mt. Sinai School of Medicine

Centra Health

Children’s Mercy Integrated Care Solutions

Cigna

Clarify Health Solutions

Coalition to Transform Advanced Care (CTAC)

Colorado, State of

Coastal Carolina Health Care

Community Catalyst Center for Consumer Engagement in Health Innovation

Community Health Choice

Community Health Plan of Washington

Connecticut, State of, Office of the Lt. Governor

Covered California

Dallas-Fort Worth Hospital Council Foundation

DC Department of Health Care Finance

Delaware, State of

Delmarva Foundation

Dignity Health

Duke-Margolis Center for Health Policy

ECL Group

Elevation Health Partners

Commitment Statement:

Elevation Health Partners is a team of quality improvement, public health, and technical health care consultants. We collaborate with state and federal agencies and commercial health care organizations to develop and implement strategies to advance meaningful, measurable improvements in all areas of the health care delivery system. We specialize in Medi-Cal and Medicare, evidence-based chronic disease management, primary care and specialty care integration, and work to drive sustainable large-scale transformation to advance new payment models and build provider capacity for quality.

As part of CMS’s Transforming Clinical Practice Initiative (TCPI), Elevation Health Partners works with 22 Federally Qualified Health Centers across Los Angeles County. The overarching goal of TCPI is to achieve large-scale health transformation by developing quality improvement strategies that readies practices to participate in an alternative payment model. The TCPI, one part of a strategy to strengthen the quality of patient care and spend health care dollars more wisely. supports innovation by promoting broad payment and practice reform in primary care and specialty care.

Using data to drive care, Elevation Health Partners has some notable achievements with our 22 assigned FQHCs:

Evaluate and select an organization-wide risk stratification methodology. None of the health centers were stratifying risk for the clinic population. Now, all 22 health centers stratify risk for the diabetic population and those needing mental health services to ensure case management aimed to prevent hospital admissions and readmissions.
Empanel Providers. Empanelment is demonstrated to reduce overall system costs, through healthier patients, fewer emergency room visits and hospital readmissions. Recognizing lack of technical tools for empanelment, Elevation Health Partners developed an Access Database tool. Only 5 of 22 health centers were empaneling providers prior to Elevation Health Partners assistance. Now all 22 health centers are actively running empanelment calculations, adopting best practice policies and procedures for empanelment, obtaining board approval, and are expected to upload empanelment assignments in the EHR by June 2018. The next phase of this effort includes implementation support, quality control, and data monitoring.
Improve data validation and reduce data leakage. Throughout 2017, Elevation Health coaches provided in-depth education and hands on support on proper EHR documentation, encounter, coding and claims submissions. This resulted in a 25% improvement for HbA1c poor control levels and 28% improvement in depression screening and follow-up across all practices year-to-date. This not only provides a greater amount of incentive dollars to our practices, but additionally resulted in a reduction in health care dollar expenditures.

Activities:

The following are ways in which we prepare clinicians to take on risk in alternative payment models:

Develop and provide strategic guidance to county government, health plans, IPAs, associations, advocacy groups, and clinic leaders in the LAPTN Transforming Clinical Practice Initiative (TCPI)
Provide hands on and technical support in practice assessment, quality improvement, and evidence-based care guidelines to drive and accelerate health care delivery system transformation
Offer PCMH content support and technical assistance to achieve and advance NCQA PCMH recognition

Website:

Elevation Health Partners

Evolent Health

Excellus Blue Cross Blue Shield

FamiliesUSA

Geriatric Specialty Care

Gold Coast Health Plan

Great Plains Quality Innovation Network

Commitment Statement:

As a Quality Improvement Organization, we understand the importance of and fully support measuring progress towards goals, both in the HCP LAN and internally within our organization. We commit to leveraging our quality improvement work to support the providers across the healthcare spectrum being introduced to these alternate payment models for the first time. We have been supporting healthcare providers throughout the various payment model/incentive changes for many years, including Hospital Value Based Purchasing, PQRS, Meaningful Use, the Readmission Reduction Program, and the HAC Reduction Program.

Great Plains QIN commits to continuing to be the local “go to” organization for providers with questions about CMS quality and payment initiatives. Some of the work that we are currently performing in the 11th Statement of Work – forming community coalitions to better coordinate care – confirms that we are a neutral convener of healthcare partners regardless of care setting, health system, or payer.

We have specific recruitment, technical support, and outcome goals in the 11th SOW that aligns very well with those of the LAN. A few examples of goals of moving to value over volume are:

Recruiting 75% of our 1-star nursing homes to participate in a collaborative to improve quality
Assisting 50% of our nursing homes to achieve a Quality Composite Score (a cumulative measure CMS created comprised of 13 quality measures) less than 6.0
Lowering statewide readmissions and admissions per 1,000 beneficiaries by 2%
Helping 55% of eligible hospitals perform better than the national median for the Hospital Value-Based Purchasing Program
Helping 60% of MIPS-eligible clinicians complete CME/CEU education

The alternative payment models being introduced by CMS have already had a direct positive impact on our work. With the numerous quality improvement projects that providers have participated in over the last decade, they are seeing why it was important that we were working with them to reduce infections or avoid re-hospitalizations. Healthcare providers have realized that quality and payment will go hand-in-hand in the future.

Website:

Great Plains QIN

Greenville Health System

Health Care Service Corporation

Healthcentric Advisors

HealthInsight

HealthPartners

Health Services Advisory Group (HSAG)

Henry Ford Health System

Commitment Statement:

Henry Ford Health System is an integrated health care system that has included hospital and medical group components in a tightly aligned structure for over 100 years, and health plan, long-term care, and other components for 30 or more years. Henry Ford Health System is firmly committed to expanded participation in a variety of forms of Alternative Payment Models. There is a strong historic base already for participation in “alternative payment models”, with the Henry Ford Medical Group having provided care for Health Alliance Plan members (the System-affiliated health plan) under a full-risk capitation agreement for over 25 years.

We have recently begun participation in the CMS Next Generation ACO program (Category 3B in the HCP LAN APM Framework), and have applied for participation in the CMMI Oncology Care Model demonstration (Category 3A in the Framework) in both the provider and plan roles. We participate in a variety of value-based contracts with Blue Cross Blue Shield of Michigan, and have begun to develop agreements for tertiary and quaternary service provision with other local and regional ACOs. Most of these arrangements would be classified as Category 2C, since they involve tangible financial rewards for actual performance on defined quality metrics. We have recently joined the Federation Care Network, a collaboration of integrated health systems in Michigan that has been created to enter into value-based contracts with public and private payers.

The full-risk capitation arrangement that existed for many years between the Henry Ford Medical Group and Health Alliance Plan would exemplify a Category 4B model. The agreement has been modified recently to move to a form of shared risk between plan and medical group, but the financial risk still retained by the medical group (approximately one-third of total) represents a significant risk for a defined population held by a provider entity, and would also exemplify a Category 4B agreement.

The recently-completed “Strategic Path” for HFHS includes a strong commitment to growth of involvement in APMs, under three specific strategic programs:
(1) “Integrated Care and Coverage”, involving individuals who are both members of the HFHS-affiliated health plan (Health Alliance Plan) and patients in the HFHS delivery system at the same time;
(2) “Value-Based Care”, involving individuals who are patients in the HFHS delivery system but insured through a different private or public entity; and
(3) “Complex Tertiary Care” involving patients who come to HFHS for high-end specialty, inpatient, or procedural services, perhaps through bundled payment arrangements with a variety of payers.

We have declared a goal of expanding the pool of individuals in the “Integrated Care and Coverage” category from approximately 125,000 to 500,000 over the next 5-10 years. An expansion of this size would mean that “ICC” would expand from approximately 20% of overall system revenue to 50%. Progress toward that goal will be measured every year. We also expect that revenue in other domains (e.g., tertiary care) will also come increasingly through value-based contracts, but we do not have specific quantitative goals or timelines in those areas.

Website:

Henry Ford Health System

HRHCare

Humana

Idaho Department of Health and Welfare – Office of Healthcare Policy Initiatives

Commitment Statement:

As part of Idaho’s pursuit of the Triple Aim, we will move from a FFS payment model (current environment – Category 1) that rewards volume of service to new value based payment models to incentivize better models of care and lower overall medical costs. This statewide payment transformation will involve a variety of approaches on the part of Idaho’s major payers, including commercial payers, Medicare and Medicaid. Idaho recognizes the importance of offering flexibility to payers in defining how they will support payment reform. Each payer is at a different place on the APM framework. For example, one payer is incentivizing providers through an accountable care organization model with shared, upside risk, expecting to evolve to a full risk model in the future.

Within this broader statewide payment model transformation, several of Idaho’s payers have committed to alternative payment arrangements with Idaho’s healthcare providers. These new payment models will incentivize, support, and reward the improved care given through the PCMH model, which will reduce high-cost care through patient management, including lowering ED utilization, hospital admissions and re-admissions, reduce neo-natal intensive care use, and increase the use of generic prescription medication. It is anticipated that these trends will decrease the cost of healthcare in the State.

Idaho has adopted the LAN framework of Alternative Payment Models and remains committed to transitioning Idaho from a fee for service structure to a population based payment structure. Commercial payers have demonstrated their commitment to negotiations that will lead to value-based payment arrangements with providers within their network that advance the goals. The payment transformation, both at a statewide level and in support of the SIM PCMHs, will not occur immediately. Transforming payment requires negotiations and contracting between the payers and providers. To avoid anti-trust, each payer must negotiate separately with each provider.

Website:

Idaho Office of Healthcare Policy Initiatives

Inland Empire Health Plan

InnovaCare

Integrated Healthcare Association

Iowa Medicaid Enterprise

IPRO & The Atlantic QIN/QIO

Commitment Statement:

IPRO and its Atlantic Quality Innovation Network (AQIN), commit to developing innovative approaches to evaluate healthcare cost and quality that permit payers and consumers to readily identify performance that is high-value, based on the three-part aim of better health, better healthcare and smarter spending.

IPRO believes that the work we’re doing—highlighting physician practices that meet stringent Advanced Primary Care criteria and promoting the cost and quality performance of ACO-served geographic areas, versus non-ACO areas—offers important educational support to value-based payment reform. By advancing the learning curve among consumers, patients and family care-givers, we will be building the case for Category 3 and 4 APMs as a value proposition. While IPRO doesn’t provide care, we have an important role to play in educating the lay public on the importance of recognizing and rewarding high-quality, cost effective healthcare.

Advanced Primary Care Scorecard

IPRO’s Managed Care Department is currently designing an Advanced Primary Care (APC), scorecard to evaluate cost and quality performance at the individual practice level and across payers. The initial scorecard will include a total of 13 cost and quality measures, including hospital utilization, preventive care and total cost per member per month. Under the auspices of the New York State Department of Health, IPRO will offer technical assistance to health plans to assure data accuracy and to evaluate attribution logic. Additionally, IPRO will aggregate performance across payers, producing reports at the regional and state-wide levels.

Success of the APC scorecard will be measured by whether the NYSDOH converts this effort from a pilot-study to a required, publicly-reported performance report for practices across New York.

Why Not the Best Website

Additionally, IPRO will use the freely-available WhyNotTheBest quality improvement website it created and manages to compare and contrast the performance of Accountable Care Organization (ACO)-participating providers against non-participating providers. By accessing ACO “quality footprint” information, visitors to the website will be able to contrast quality and cost performance across dozens of measures between regions that are and are not served by ACOs. IPRO will collect and publish comparative cost and value information on a range of quality and utilization measures, including procedures, visits and imaging.

Success of the ACO “quality footprint” data collection and analyses will be measured by surveys of users, who will be asked to rank the website for timeliness, ease-of-use and other user experience measures.

Website:

IPRO

The Atlantic Quality Innovation Network-Quality Improvement Organization (AQIN-QIO)

AQIN

Press:

IPRO Joins Healthcare Payment Reform Campaign

iTether, LLC

Commitment Statement:

For behavioral health treatment providers, iTether is the patient engagement platform that provides real-time patient activation for improved outcomes. Through the provider portal and patient app, iTether platform connects patients, providers, and payers to empower data-driven decisions across the continuum of care. We enable the delivery and measurement of treatment to more patients at a lower cost to improve long-term health outcomes.

iTether LLC’s mission is to raise the standards in behavior modification services by engaging patients, delivering accountability, and improving long-term success rates. Our products are customizable and integrated across all levels of treatment services – patients, providers, and payers. We deliver evidence-based outcomes which lead to performance-based payments. At iTether, we believe that documenting the delivery of treatment and resulting outcomes provides a strong foundation for a successful APM-based program.

We accelerate APM adoption by using modern data collection methods for surveys and assessments that extend beyond the clinical walls and support APM adoption by streamlining the correlation of patient-generated health data (PGHD) to contracted quality measures.

Clinicians use the iTether Patient Engagement Platform to provide ongoing guidance, quality surveys, and health assessments to patients outside of the clinical environment as part of patient care and case management. This includes the collection and use of patient-generated health data (PGHD), which is correlated to the Provider’s contracted Quality Measure Performance (QMP) incentive arrangement, under which the Provider may receive additional funds over and above the capitation rates for performance on select quality measures.

Activities:

Create and capture value-based care data
Support APM/ value-based care symposiums
Support integrated healthcare teams in APMs to deliver patient-centered care

Website:

iTether, LLC

Johnson & Johnson

Kaiser Permanente

Kern Health Systems

The Kinetix Group

M3 Information

Maine, State of

Massachusetts, State of

McKesson Corporation Connected Care and Analytics/Extended Care Solutions

Medicare Rights Center

Michigan Department of Health and Human Services

Minnesota State Employee Group Insurance Program

Montefiore

Mountain-Pacific Quality Health

Montana Department of Public Health and Human Services

MPA Healthcare Solutions

Commitment Statement:

MPA Healthcare Solutions is pleased to make a commitment to support the Health Care Payment Learning and Action Network. As long‐time health care outcomes researchers, our team strongly supports the “Better, Smarter, Healthier” alternative payment model Medicare goals announced by Secretary Burwell. MPA understands that many organizations are committed to these principles, but may not yet have sufficient infrastructure to participate in alternative payment models. In order to accelerate adoption, MPA commits to offering the following essential analytic services to support providers and payers in the transition from fee‐for‐service to alternative payment models:

Clinically‐appropriate eligibility determinations;
Risk‐adjustment of patient populations;
Validation of administrative data models using EHRs and other clinical data sources;
Development and validation of new metrics to help providers measure clinical outcomes;
Tools to monitor efficiency and effectiveness improvement interventions;
Provider education on alternative payment model implementation;
Development and dissemination of rigorous methods to achieve the above goals, within the peer‐reviewed scientific journal literature

MPA currently offers the above services to support alternative payment model implementation, and we commit to continuing to offer this suite of services to an expanding group of providers. We have also set the goal for 2016 to offer our first concurrent risk‐assessment tool to support decision support for providers caring for patients under population‐based payment contracts. We understand that timely data on patient risk is a foundation for care redesign efforts prompted by alternative payment models, and are excited to develop enhanced tools in this critical area. MPA also commits to maintaining a strong research and development program, as we recognize that only by engaging in a robust dialogue about appropriate methods can we develop tools that help payers and providers make improvements to the health care system that above all serve the best interests of patients. We have set the ambitious goal to publish ten new studies on health care outcomes measurement in the next two years (by 2018), and are thrilled to share that we are already making significant progress toward that goal with 3 new peer‐reviewed journal publications in 2016.

Drawing on our experience as an independent third‐party providing analytic infrastructure to both providers and payers, MPA:

Agrees to work with Network participants to establish standard definitions for alternative payment models;
Supports measurement of progress towards goals set by HCPLAN members on behalf of the U.S. health care system;
Commits to reporting progress towards goals for alternative payment models.

Website:

MPA Healthcare Solutions

National Kidney Foundation

National Partnership for Women & Families

National Rural Accountable Care Consortium

National Safety Net Advancement Center (SNAC) at ASU School of Medicine

Network for Regional Healthcare Improvement (NRHI)

New Hampshire Department of Health and Human Services

New York State of Health

Ohio, State of

Omada Health, Inc.

Commitment Statement:

The Omada Program is a digital therapeutic based on the Center for Disease Control’s (CDC’s) National Diabetes Prevention Program (DPP), designed with the goal of the prevention of obesity-related chronic diseases. Through an engaging digital experience, participants focus on the goals of losing body weight and increasing physical activity.

Omada ties all reimbursement/payment to engagement and participant outcomes in the program. After one initial reimbursement when the patient initiates the program, Omada’s monthly revenue is solely based on the percent of weight loss achieved by that participant in that month. There are no other charges for any element of the program.

Omada provides a valuable tool to organizations engaged in APMs by allowing them to address a population most likely to drive healthcare spending in the very near future. These individuals, already at the tipping point of diabetes, will soon be among the highest utilizers of healthcare resources. DPP’s focus on behavior change – diet, exercise, sleep, and stress – to support weight loss is important given the proven, direct relationship between weight loss, biomarker improvement, and chronic disease risk reduction. Omada enables organizations to intervene with these individuals before they develop chronic conditions.

Actions:

Drive value based reimbursement models for digital health.
Apply and advocate for medical coding that supports alternative payment models.
Support APM by enabling health systems and payers to reduce costs associated with the development of chronic disease.

Commitments:

Educate members/stakeholders/consumers on the importance of APM adoption
Provide written and technical resources and assistance in support of APM adoption
Spread best practices around APM adoption
Encourage business associates to operate under value-based payment arrangements/APMs
Influence policy makers regarding the merits of APM adoption
Invite LAN experts to speak at meetings/events
Share LAN materials and information
Encourage partners and stakeholders to provide input into LAN activities
Provide leadership on and participation in LAN committees and workgroups

Website:

Omada Health, Inc.

Oncology Hematology Care

Optimity Advisors

Optum

Oregon Health Authority

Pacific Business Group on Health

Commitment Statement:

1. Accelerate the adoption of effective ACO models by health plans, providers, and purchasers. In 2016, leverage PBGH’s ACO learnings and best practices to influence national policy, and develop an ACO action plan by testing models for how PBGH can accelerate adoption of effective ACO models. Nationally disseminate the PBGH guidebook on ACO best practices and test at least three mechanisms for accelerating adoption of effective ACOs.
2. Create and spread approaches, in payment and delivery, to improve care and reduce inappropriate services for patients and issues incurring high costs for our members (e.g., maternity, medically complex).
a. Expand the Transform Maternity Care program. In 2016, secure commitments from California hospitals to participate in learning collaboratives representing 25% of births. Obtain commitments from 5 purchasers to integrate PBGH-endorsed maternity metrics into health plan contracts by 2018.
b. Expand PBGH’s high-cost care models nationally. Engage five non-California regions around high-value maternity care and obtain commitment from one regional partner outside of California to implement elements of the PBGH maternity model in 2016. Spread adoption of common care elements for high-cost patient populations.
3. Accelerate the adoption of bundled payments by health plans, providers, and purchasers in 2016. Create the foundation for broad adoption of bundled payments and gain commitment of purchasers to adopt PBGH bundled payment recommendation. Specifically, gain commitment of 15 purchasers to implement bundled payment program by 2018 that meets PBGH criteria/standards.
4. Develop and spread best practices for payment and delivery reform among purchasers nationally. In 2016, launch Purchaser Value Network. Meaningfully engage at least five regional purchaser coalitions and associations, 50 individual companies and five state purchasers.
5. Increase the number of PBGH members adopting value purchasing and APMs. Work with PBGH members to establish, monitor and achieve individual and collective targets for value purchasing and APM adoption. In 2016, produce an annual report of PBGH member organizations’ adoption of value purchasing and APMs.

Website:

Pacific Business Group on Health

Paradigm Provider Partners (P3)

Partners Healthcare

Patient Advocate Foundation

Commitment Statement:

In order to increase the LAN goal of adoption of alternative payment models (APMs) and to incentivize quality and value over volume, The Patient Advocate Foundation (PAF) believes patients need to play a central role in defining value and quality in health care. At PAF, we help patients overcome multiple barriers as they seek access to their health care and we carefully document the nature of the hurdles encountered and what was done, or could not be done, to deliver quality care.

PAF continues to take a leadership role in securing the best information on how patients interact with their health care. To that end, PAF has launched the Consumer-Based Cancer Care Value Index (CCCVI), a patient satisfaction survey tool designed to identify variations in the patient care experience and gaps in access to key support services. With this information, patients can help their providers better target the services they need and those that may be lacking in their care.

Our desire is to quickly engage multiple sites across the country to use this tool and then report back the experiences of the patient and what they value in their care and what was missing. The CCCVI provides novel ways of measuring care experience. The goals of the CCVI are:

To publish our results to understand which aspects of cancer care that are misaligned with patients’ values, what these may be and which are significantly associated with worse self-reported mental and physical health outcomes
A secondary goal is to inform future research to investigate whether prospectively providing cancer care that better aligns with patients’ values leads to better mental and physical health
A final goal is to take what we learn in the oncology setting and apply this to other disease areas

The CCCVI results can be used as a tool to build models in Category 3 (FFS Architecture) to incent and or reward care that address what an oncology patient values as demonstrated by the results obtained using the CCCVI. While the tool is focused on the care oncology patients receive, the site of care may well be independent, which means the results are applicable to either a primary care or specialist’s site.

As more data is collected and the dataset becomes richer across a larger oncology patient pool, it is conceivable that a population-based reimbursement model that focuses on incenting and rewarding care based on what a patient values can be developed .

Website:

Patient Advocate Foundation

PatientPing

Pennsylvania Department of Health

Pioneer Health Alliance

Premier

Primary Care Partners

Priority Health

Privia Medical Group

Qualis Health

Rhode Island, State of

Rite Aid

Rocky Mountain Health Plans

Saturn Care

SelectHealth

The Sequoia Project

SSM Health

Suncoast RHIO

Texas Children’s Health Plan

ThedaCare Center for Healthcare Value

Trinity Health

Tucson Medical Center

United Healthcare

University of Arizona Health Plans

University of Iowa Health Alliance

UPMC Health Plan

Vanderbilt University Medical Center

Vizient

Commitment Statement:

Vizient believes that by bringing together groups of diverse health care stakeholders and providing them with knowledge and access to other likeminded individuals that we will be able to accelerate the transition to new models of care and the alternative payment models necessary to support them. To that end, as a Committed Partner Vizient will commit to take the following actions to help advance the objectives of the Health Care Payment Learning and Action Network:

1) Vizient will use the resources it has available, particularly in the areas of education, broadcasting and networking, to raise awareness among clinicians, administrators, and other health care professionals of developments and accomplishments related to value-based payments and alternative payment models. We propose to use our VHA TV studio to broadcast at least one program each year on payment transformation/alternative payment models as well as periodic webinars and other educational forums.

2) Vizient will convene its member organizations across the country, as needed, to obtain feedback on important proposed policy/operational models and will share that feedback with CMS and the Health Care Payment Learning and Action Network in order to guide the further development and dissemination of value-based payment structures and alternative payment models.

3) Vizient, through its Practice Transformation Network (PTN) within the CMS Transforming Clinical Practice Initiative (TCPI), will work with our participating clinicians (6,000 currently; 20,000 target) to help them transform their practices to achieve the Fifth Phase of TCPI Transformation – “thrive as a business via pay-for-value approaches.” We will “graduate” participating clinicians from fee-for-service models to alternative payment models consistent with the expectations CMS provided all PTNs as a condition of award. We believe at least 50% of current clinicians will be operating under an alternative payment model by the end of the program (2019).

We believe these actions, together with the leadership role that Vizient plays in the health care ecosystem, will help advance the transformation of the health care payment system to one that reflects and rewards value over volume and innovation over the status quo. Vizient will be honored to work with CMS, the Health Care Payment Learning and Action Network and other Committed Partners to bring about better care for the individual, better health for communities and smarter spending on health care expenditures.

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Vizient, Inc.

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Westchester Health

WL Gore and Associates

Commitment Statement:

For more than 50 years, and with more than 40 million innovative medical devices implanted, Gore has thrived by providing its customers with high-value products that enhance the quality of life. The evolving value-based healthcare environment creates an imperative to measure and improve quality of care. It is our commitment to partner and participate in activities and initiatives which focus on value, quality, improved outcomes and shared decision-making between providers and their patients.

A commitment to innovation shapes everything we do. This core principle aligns with the partnership necessary to accelerate transition towards APMs.

Actions:

Partner in the development of Quality Measures.
Engage in activities that promote appropriate implementation of Episodes. For example, Gore intends to use quality and performance assessments of our devices, in part, to inform a variety of Measurement parameters, such as CMS’s Aortic Aneurysm Episode.
Promote initiatives that focus on value, quality and improved outcomes. Gore, as a qualified repository of significant clinical data, can inform the work of clinicians to develop Quality Measures which more precisely demonstrate how the use of medical devices in procedures impacts value, quality and improves outcomes. Ever respectful of the implications and limitations on industry engagement, Gore is currently exploring ways in which we can collaborate with the clinician community to accomplish these goals.

Commitments

Educate members/stakeholders/consumers on the importance of APM adoption
Provide written and technical resources and assistance in support of APM adoption
Spread best practices around APM adoption
Encourage business associates to operate under value-based payment arrangements/APMs
Influence policy makers regarding the merits of APM adoption
Invite LAN experts to speak at meetings/events
Share LAN materials and information
Encourage partners and stakeholders to provide input into LAN activities

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WL Gore and Associates

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