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.