OVERVIEW
The most effective APMs for resiliency are those that deliver on quality and cost for a population, while also supporting financial stability, even during a major crisis in the healthcare system. HCP-LAN APM Framework Category 4 models are based on prospective, population-based payments, and promote resiliency by encouraging providers to deliver well-coordinated, high-quality, person-centered care. Expansion of the pathway to Category 4 models, as well as improving APM design in other ways – such as improving equity-focused design – will promote future resiliency.
- Category 4 APMs involve prospective, population-based payments, structured in a manner that encourages providers to deliver well-coordinated, high-quality, person-centered care within either a defined scope of practice (4A), a comprehensive collection of care (4B), or a highly integrated finance and delivery system (4C).
- Category 4 APMs can promote resiliency by providing a more stable, consistent revenue stream
MISSION
Identify and disseminate best practices for payer supports and payer-provider collaboration to help providers recover from the impact of the PHE;
Facilitate the transition into the most effective APMs possible, as providers build on innovative care models to recover from the pandemic; and
Support further actions to identify,
scale, and evolve effective APMs.
VISION
A healthcare system that is responsive and resilient to events such as the unprecedented PHE and achieves improved patient experiences and outcomes, reduced disparities, and greater affordability and accessibility – NOT just a system that recovers to previous models of care and payment. In collaboration, payers and providers can lead the way through actions that shift payments from FFS approaches that have not worked well in the PHE and into effective APMs.
HEALTHCARE RESILIENCY FRAMEWORK
In collaboration, payers and providers can lead the way through actions that shift payments from FFS approaches that have not worked well in the pandemic and into effective APMs. The below framework describes key actions that payers, providers, and multi-stakeholder groups can take in both the short-term and medium- to long-term to promote more resilient, effective APMs. The actions are inter-related and an organization’s strategy for resiliency is likely to involve a combination of the actions.
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.
