Principles of Alternative Payment Models Framework

HCPLANGreetings PolicyPub patrons. I would like to take a moment and share with you a whitepaper recently published by the Health Care Payment Learning and Action Network. The purpose of the whitepaper is to provide a roadmap to measure progress and establish a shared language and common set of conventions to help facilitate discussion and debate regarding alternative payment models (APM).

A group that I have actively participated in since its inception back in March of this year, HCPLAN was established by the Department of Health and Human Services, “to help achieve better care, smarter spending, and healthier people.” It’s primary purpose is to serve as a convener and facilitator (as well as catalyst) in pursuing HHS’s stated goals of:

  • tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2016 and 50 percent by 2018; and
  • tying 85 percent of all Medicare fee-for-service to quality or value by 2016 and 90 percent by 2018.

    The whitepaper identifies seven Key Principles for the APM Framework that all healthcare providers should be aware of and understand:
  • Principle 1: Changing the financial reward to providers is only one way to stimulate and sustain innovative approaches to the delivery of patient-centered care. In the future … it will be important to monitor progress in initiatives that empower patients (via meaningful performance metrics, financial incentives, and other means) to seek care from high-value providers and become active participants in clinical and shared decision-making.

    Principle 2: As delivery systems evolve, the goal is to drive a shift towards shared-risk and population-based payment models, in order to incentivize delivery system reforms that improve the quality and efficiency of patient-centered care.

    Principle 3: To the greatest extent possible, value-based incentives should reach providers who directly deliver care.

    Principle 4: Payment models that do not take quality and value into account will be classified in the appropriate category with a designation that distinguishes them as a payment model that is not value-based. They will not be considered APMs for the purposes of tracking progress towards payment reform.

    Principle 5: In order to reach our goals for health care reform, the intensity of value-based incentives should be high enough to influence provider behaviors and it should increase over time. However, this intensity should not be a determining factor for classifying APMs in the Framework. Intensity will be included when reporting progress toward goals.

    Principle 6: When health plans adopt hybrid payment reforms that incorporate multiple APMs, the payment reform as a whole will be classified according to the more dominant APM. This will avoid double-counting payments through APMs.

    Principle 7: Centers of excellence, patient-centered medical homes, and accountable care organizations are delivery models, not payment models. These delivery system models enable APMs and, in many instances, have achieved successes in advancing quality, but they should not be viewed as synonymous with a specific APM. Accordingly, they appear in multiple locations in the Framework, depending on the underlying payment model that supports them.

    HCPLAN is open to anyone interested in being kept informed of and joining the conversation on HHS’s efforts to  develop new payment models intended to be structured around all of the buzzwords you’ve heard over the past five years now: e.g., value, quality, transparency, patient activation, evidence-based, and so on.

    What it is not, based on my experience, is a veiled promotional vehicle to evidence broad-based support of new payment models that go largely unchallenged. To the contrary, there is a great deal of practical concern being expressed supported by real life experience having already pursued new payment models – the good, the bad and the ugly. To participate in HCPLAN, just visit the registration web page.

    Cheers,
      ~ Sparky

Health Care Payment Learning and Action Network

Back view of businessman drawing sketch on wallAs shared here in the Pub at the end of January (Value-Based Payment: The Rush Is On) HHS has set a goal of migrating 30% of all Medicare payments to alternative payment models by December of next year – and 50% by the end of 2018. Overall the goals of having all payments tied to quality or value are 85% and 90% during the same periods, respectively.

Commensurate with these initiatives CMS today announced the establishment of the Health Care Payment Learning Network, to provide a forum for public-private partnerships to help the U.S. health care payment system (both private and public) meet or exceed recently established Medicare goals for value-based payments and alternative payment models.”

The Network will perform the following functions:

Serve as a convening body to facilitate joint implementation of new models of payment and care delivery;
Identify areas of agreement around movement toward alternative payment models and define how best to report on these new payment models;
Collaborate to generate evidence, share approaches, and remove barriers;
Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, quality and performance measurement, risk adjustment, and other topics raised for discussion; and
Create implementation guides for payers, purchasers, providers, and consumers.

CMS is asking for payers, providers, employers, purchasers, state partners, consumer groups, individual consumers, and others to join the network in order to participate in the discussion and debate on how to transition toward the aforementioned goals via alternative payment models. The Network is to be convened by an independent contractor that will help ensure it operates independently of HHS, CMS and other governmental entities while supporting the efforts of Network participants.

A Guiding Committee made of participants from the Network will be created to act as a clearinghouse of topics and ideas and to help prioritize discussion topics based upon the input they receive from Network participants. The frequency of meetings is to be determined but it is intended that most will be held virtually via teleconference and/or webinar. A kickoff event is being scheduled for Wednesday, March 25th.

I have signed up as a network participant to follow the activities and information provided from the Network and will share more on this blog down the road.

Cheers,
  ~ Sparky

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