New Online Tool Helps Providers, Payers with APM Implementation

April 03, 2019 - The Health Care Payment Learning & Action Network (LAN) recently launched an interactive, online tool that aims to help providers, payers, and other healthcare stakeholders identify the challenges and opportunities with alternative payment model (APM) implementation.

The Roadmap for Driving High Performance in Alternative Payment Models, or Roadmap, shares key insights from payers and providers who have successfully adopted and implemented APMs. Based on direct conversations with the stakeholders, LAN developed current success strategies and actions payers and providers should know to reduce costs while improving care quality.

“For many providers, the transition from fee-for-service to fee-for-value is a journey marked by uncertainty, doubt, and many unanswered questions,” Renee McLaughlin, senior medical director for value-based relationships at Cigna and LAN guiding committee member, stated in an emailed press release. “The Roadmap is a valuable tool that can provide insight and guidance to providers new to the field of population health as well as to seasoned experts, easing and accelerating the path to success in value-based care delivery.”

Healthcare payments are slowly, but surely transitioning away from fee-for-service. In fact, LAN reported in October 2018 that the majority of payments made in 2017 were tied to value and/or care quality to some degree.

However, only about one-third of healthcare payments that year were paid under an APM that has some level of financial risk, ranging from upside rewards for appropriate care to integrated finance and delivery systems.

LAN intends for the Roadmap to help accelerate the industry’s shift to value-based reimbursement that holds providers financially accountable for the care they provide. That means helping providers and payers develop successful APMs and helping the stakeholders implement them appropriately.

Through LAN’s 22 interviews with stakeholders engaging in 10 APMs, the industry group found that payers and providers should focus on APM design, payer-provider collaboration, and person-centered care to successfully implement the models.

Roadmap users can navigate through the three APM implementation categories to explore key components and learn about “promising practices” that can aid payers and providers with the transition to value-based reimbursement.

For example, LAN found that payer-provider collaboration for successful APM implementation hinges on APM design collaboration and provider engagement, data sharing and analytics, care management support, and effective leadership and organizational culture.

Roadmap users can dive deeper into each of the four payer-provider collaboration strategies to unlock promising practices. For instance, payers and providers should be working together on APM design, and the stakeholders can achieve the goal by establishing venues, processes, and shared understanding to facilitate discussion and encourage collaboration with providers, LAN stated on the interactive tool.

Payers and providers should also reach an agreement on foundational elements of APM design, the industry group added referring to payer-provider collaboration strategies. To do this, stakeholders should conduct formal evaluations of population-based models and work closely with specialists to align clinical and payment models, the Roadmap continued.

Each of the three major categories contains promising practices that support APM implementation.

LAN intends for the Roadmap to help providers just dipping their toe into value-based reimbursement and those who are seasoned veterans. Additionally, the industry group expects the Roadmap to help patients, purchasers, and policymakers to gain a better understanding of the challenges and opportunities related to APM implementation.

“The Roadmap was created to support the ongoing effort to transform the system from fee-for-service to value payment, to achieve better outcomes at lower costs for all patients,” Mark McClellan, LAN guiding committee co-chair states in the release. “Our goal is for this tool to reach a broad audience that can find information in the broad array of promising practices that can support ongoing value payment efforts.”