Over one third of all US health care payments are already flowing through alternative payment models – Where does your organization stand?
The Health Care Payment Learning and Action Network (LAN) was launched in 2015 to accelerate the health care system’s transition to alternative payment models by combining the innovation, power, and reach of the private and public sectors. By sharing information about successful models and encouraging private entities to share their best practices, the LAN works to reduce barriers and accelerate adoption of APMs.
The development and adoption of alternative payment models (APMs) is central to revolutionizing health care payment in the United States. APMs can realign treatment and payment incentives with the aim of improving care quality while managing cost.
The Health Care Payment Learning and Action Network (LAN) is measuring nationwide progress toward alternative payment model (APM) adoption as a means to a more effective health care system. As leaders in this space, participating health plans will contribute to that understanding.
How are health care payments shifting from traditional fee-for-service to alternative payment models (APMs)? Where does the nation stand on APM adoption in commercial, Medicare Advantage, and Medicaid markets?
Having a common definition of alternative payment is critical to our ability to move forward together. When health plans report payments in alignment with the Health Care Payment Learning and Action Network (LAN) APM Framework, you gain an understanding of your position in the market.
The LAN is currently recruiting health plans and other payers (e.g. state Medicaid agencies) to participate in the 2022 APM Measurement Effort. Grab a seat at the table as health plans across the country contribute to our collective understanding of progress in APM adoption. Your participation will inform and bolster our understanding of nationwide progress toward APMs, and thus give you a better idea of where you stand in relation to other health plans.
The HCP-LAN will resume its regular annual Measurement Effort in the Spring/Summer of 2022 (collecting 2021 APM data). 2021 APM results will be released in 2022.
For 2021, participating payers will report total in- and out-of-network health care spending paid to providers through each of the categories and subcategories during 2021 or the most recent 12 months in the commercial, Medicaid and Medicare Advantage markets. The LAN works directly with participants to classify payments according to the Refreshed APM Framework. This makes participation as simple and straightforward as possible.
Individual payer data will be kept strictly confidential. It will not be shared with other participants or parties outside of the LAN data collection team. For reporting purposes, individual payer data will be aggregated with data from other payers.
More detailed information and helpful resources on this year’s 2022 APM Measurement Effort are linked below:
The LAN’s APM Framework provides standardized definitions and categories of APMs. The LAN published the original APM Framework in January of 2016 and refreshed it in 2017. The LAN will continue to use the category definitions from the refreshed APM Framework to measure APMs, using similar metrics and methodology as were used in 2020 and 2021.
The LAN’s fifth APM Measurement Effort, which included data on roughly 216 million Americans (73% of covered lives) in 2020 and 239 million Americans (80% of covered lives) in 2021. The data revealed that 38.2% of health care payments made in 2019 flowed through APM categories 3 and 4, and 40.9% of health care payments made in 2020 flowed through APM categories 3 and 4.
The 2022 Measurement Effort will provide information on payments made in 2021, allowing for an indication of the movement toward APM adoption. The 2021 survey results will be released in the Fall of 2022.
“The LAN survey motivated us to look deeper into the volume of our payments tied to APMs. The LAN survey results were used as an effective tool to help drive strategic objectives within our organization moving forward.”
Mary H. Syiek
Senior Vice President, Provider & Member Engagement and Operations
Molina Health Care
“The movement to APMs is an inevitable direction for both health plans and the provider community. Participating in the LAN’s measurement effort is valuable for understanding how quickly things are evolving.”
David Hochheiser
SVP of Medical Economics
Blue Cross and Blue Shield of Louisiana
“We welcome the attention the LAN survey brings to APM adoption. We’re hearing from more providers who prefer to be paid this way; we continue to expand APMs and urge other payers to move in the same direction.”
Eileen F. Wood
Senior Vice President, Clinical Integration
Chief Pharmacy Officer
Capital District Physicians’ Health Plan, Inc. (CDPHP)
OMB Control Number: 0938-1297
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.
