In January 2015 Health and Human Services Secretary Sylvia Burwell announced an accelerated transition to alternative payment models (APMs) for Medicare recipients with a target of 30 percent of payments linked to value in 2016 and 50 percent in 2018.

As part of the effort to transition America’s health care system from volume to value, the Centers for Medicare and Medicaid Services (CMS) established the Health Care Payment Learning and Action Network (LAN), which is managed by the MITRE Corporation. The ACC, as an early follower of the LAN, acquired partner status in 2015. While there are over 4,000 LAN participants, only 50 organizations have achieved partner status.

The operational model of the LAN consists of convening stakeholders, including providers, consumers, purchasers, states and federal partners, to establish a common pathway for success while identifying an agreement around the movement to APMs. Another goal is to have partners and LAN participants collaborate to identify and use existing successes, best practices and lessons learned while developing approaches to core issues such as risk adjustment, benchmarking and attribution. The LAN also drives adoption of APM models and is measuring progress toward this goal.

The LAN’s 24-member Guiding Committee, led by Mark McClellan, MD, PhD, and Mark Smith, MD, MBA, has chartered three workgroups: APM Framework and Progress Tracking, Population-Based Payment Models and Clinical Episode-Based Payment. According to the LAN, the recent release of its APM Framework White Paper “is an important milestone in the progress of the LAN toward its goal: driving new and innovative health care payment models that promise to improve the quality and value of health care.” To learn more about the LAN and explore available resources, click here.

The Health Care Transformation Task Force (HCTTF) is another group dedicated to advancing value-based payment. The HCTTF, which is currently comprised of 41 members that span providers, payers, purchasers and consumers, was formed in early 2015 with the goal of having 75 percent of respective businesses operating under value-based payment arrangements by 2020. Members of HCTTF also cross over to participation in the LAN and both organizations are collaborating in the movement to APMs. 

The ACC is following the activities of the HCTTF through participation in the Accountable Care Workgroup and the Bundled Payments Workgroup.  Each workgroup recently established goals for 2016 which include policy recommendations to be submitted as part of the regulatory comments, best practice recommendations including case studies, and toolkits.  To learn more about the HCTTF and access resources including white papers and comment letters, click here.

Both of these groups are key players to follow in the movement from a volume to value-based reimbursement environment as the impact of their deliverables and recommendations become available in 2016 and beyond.

Keywords: Benchmarking, Centers for Medicare and Medicaid Services, U.S., Delivery of Health Care, Medicaid, Medicare, Risk Adjustment, Social Responsibility

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