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.”
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