Monday, 25 January 2016 02:57

Recommendations Emerge for Groundbreaking Framework Document

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The initial deliverable of the Healthcare Payment Learning & Action Network’s (LAN’s) first work group, the Alternative Payment Model (APM) Framework and Progress Tracking Work Group, was the release of the draft APM framework document on Oct. 22, 2015. The document was reviewed at the LAN Summit on Oct. 26, with public comments accepted through Nov. 20. In addition, listening sessions were held via webinar for states, consumer and patient advocates, and purchasers and the provider community. 

The intent of the framework document is to provide terms and definitions that will be used as foundational work on the part of the work group. On Jan. 12, 2016, a webinar was held to review the final version of the document. During the webinar it was noted that 113 comments (totaling 285 pages) were received from 79 unique submitters, with 51 percent of individuals acting as representatives of their organizations. 

Using the framework released earlier in 2015 by the Centers for Medicare & Medicaid Services (CMS), this document builds upon that effort and contains a schematic divided into four categories (and sub-categories). This includes Category 1 – Fee-for-Service, No Link to Quality & Value; Category 2 – Fee-for-Service, Link to Quality & Value; Category 3 – APMs built on Fee-for-ServiceArchitecture; and Category 4 – Population-based Payment, with examples noted within each area. The document also contains an addendum with case studies submitted to the work group that are included within categories 2-4. Seven key principles for the APM framework are included as recommendations in the document to provide context for understanding the recommendations. These include:

  1. Principle 1
    Changing the financial reward to providers is way to sustain innovative approaches to the delivery person-centered care. In the future, it will be important to monitor progress ininitiatives that empower patients to have a voice in model design, to seek care from high-value providers (via performance metrics, financial incentives, and other means) and become active participants in shared decision-making.
  2. Principle 2
    As delivery systems evolve, the goal is to drive a shift toward shared risk and population-based payment models that incentivize improvements in the quality and efficiency of person-centered care.
  3. Principle 3
    To the greatest extent possible, value-based incentives should reach providers across the care team that directly delivers care.
  4. 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 toward payment reform.
  5. Principle 5
    Into reach the LAN’s goals for healthcare reform, value-based incentives should be intense enough for providers to invest in and implement delivery reforms, and they should increase over time. However, the strength of incentives does not affect the classification of APMs in the APM framework.
  6. Principle 6
    For tracking purposes, when health plans adopt hybrid payment reforms that incorporate multiple APMs, the payment dollars will count toward the category of the most dominant APM. This will avoid double-counting payments through APMs.
  7. Principle 7
    Centers of excellence, patient-centered medical homes, and accountable care organizations are delivery models, not payment models. In many instances, these delivery models have an infrastructure to support care coordination and have succeeded in advancing quality. They enable APMs and need the support of APMs, but none of them are synonymous with a specific APM. Accordingly, they appear in multiple categories of the APM framework, depending on the underlying payment model that supports them.

The Jan. 12 webinar also included a brief update on the current and future sprints of the other LAN workgroups, i.e. Population-Based Payment and Clinical Episodes. Additional information on how to participate in the LAN, along with archived webinars and material produced by the work groups, can be found online at https://publish.mitre.org/hcplan/

About the Author

Rhonda Taller is VBPmonitor’s legislative correspondent. She has over 30 years of experience with health information technology working within the vendor environment, with roles in product management, management, government affairs, and strategic consulting. Her expertise is on topics related to CMS reimbursement and quality regulations, value-based reimbursement programs, ICD-10, meaningful use, and health reform. Rhonda has held volunteer positions with HIMSS and WEDI, including appointment to the HIMSS Business Systems/Medical Banking Committee (2010-2012), chairing the HIMSS ICD-10 Task Force (2013-2014), and serving as co-chair of WEDI ICD-10 Transition Work Group.

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Last modified on Wednesday, 27 January 2016 01:10

Rhonda Taller has over 30 years of experience with health information technology working within the vendor environment with roles in product management, management, government affairs and strategic consulting.  Her expertise is on topics related to CMS reimbursement and quality regulations, value-based reimbursement programs, ICD-10, meaningful use and health reform.  Rhonda have held volunteer positions with HIMSS and WEDI including appointment to the HIMSS Business Systems/Medical Banking Committee (2010-2012), chairing HIMSS ICD-10 Task Force (2013-2014) and co-chair of WEDI ICD-10 Transition Workgroup.