Tuesday, 23 February 2016 16:28

Recent Developments for the Healthcare Payment Learning and Action Network (LAN) and Physician-Focused Payment Technical Advisory Committee (PTAC)

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The Healthcare Payment Learning and Action Network (LAN) was very busy during its formative year, 2015, educating participants and partners through its inaugural LAN Summit in October 2015, monthly webinars, newsletters, and communication on the activities of the Guiding Committee, as well as the three work groups that have been established. A prior article focused on the final version of the APM framework document released in January 2016.

The LAN’s Population-Based Payment Work Group (PBP WG) released its initial draft white papers on patient attribution and financial benchmarking in early February, with a comment period open through March 7, 2016. Presentation of the final white papers is targeted for April 4, 2016. The draft white paper, Accelerating and Aligning Population-Based Payment Models: Patient Attribution, discusses the methods for assigning patients to providers accountable for total cost of care and quality outcomes in a population-based payment model. 

In releasing the draft white paper, the PBP WG noted: “patient attribution, which identifies a patient-provider health care relationship, is a foundational component in a PBP model, and forms the basis for performance measurement, reporting and payment.” The draft white paper includes 10 recommendations for use by payors when determining which patients are attributed to provider groups within the PBP model. Within the white paper is a detailed explanation of each recommendation, along with a patient attribution flow chart (Figure 3) and comparison of the PBP WG recommendations versus Centers for Medicare & Medicaid Services (CMS) program approaches to attribution in various accountable care organization (ACO) models such as Medicare Shared Savings, Pioneer ACOs, and Next Generation ACOs (Figure 5). 

The draft white paper titled Accelerating and Aligning Population-Based Payment Models: Financial Benchmarking is intended “to provide a blueprint that can help guide the work of establishing, updating and rebasing financial benchmarks in PBP models.” The draft white paper includes five key principles regarding financial benchmarks along with recommendations relative to PBP models in categories 3 & 4 (detailed in the final APM framework document). These categories assume that providers will accept accountability for the full continuum of care. Both of the first two recommendations are further divided into sub-recommendations. For individuals and organizations considering commenting on each of the draft white papers, the PBP WG is seeking feedback on the following areas:

  • The overall white papers and recommendations;
  • Diagrams, flowcharts and tables used to illustrate key concepts; and
  • Examples that would be useful for illustrating the recommendations

Comments will be accepted through the LAN website (Patient Attribution Comment Form and Financial Benchmarking Comment Form) or online through a discussion forum on Handshake. Additional information on the LAN can be found online at https://hcp-lan.org/.

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 the WEDI ICD-10 Transition Workgroup.

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Last modified on Tuesday, 23 February 2016 16:40

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.