National APM Data Collection Effort
Health plans have an important opportunity to lead the way in gauging where we stand as a nation on the pathway to payment reform. The Health Care Payment Learning & Action Network (LAN) is seeking payers who are willing to participate in a national APM data collection effort. This nationwide effort will help the LAN assess progress in shifting U.S. health care payments to APMs. Data collection is planned to run from May 18, 2016 to July 8, 2016. Note that the end date for this collection effort, along with the content contained on this webpage, may be updated periodically based on feedback from participants and other stakeholders.
Payers who are interested in participating in this APM collection effort can send an email to anne.gauthier.lan@mitre.org.
Moving toward HHS and LAN shared goals
Paralleling the Department of Health and Human Services’ (HHS) Medicare spending goals, the LAN has set goals for the entire U.S. health system of achieving 30% adoption of APMs by 2016 and 50% by 2018. In early March, HHS announced that an estimated 30% of Medicare fee-for-service payments are now tied to APMs, thus reaching the first HHS milestone almost a year ahead of schedule. The LAN is undertaking this nationwide data collection effort to determine the level of progress achieved by the private sector and state Medicaid programs towards its APM adoption goals, and to help the delivery system plan for the pace of change in health care payment. This survey will also provide a snapshot of the APM landscape, identifying the various types of models being employed by commercial, Medicaid, and Medicare Advantage plans. The ultimate goal of this effort is a consistent and harmonized “apples-to-apples” comparison of the various payment models in use nationwide.
Background on APM Framework
In order to track the LAN’s progress towards these goals, standardized definitions and categories of APMs were needed, along with measurement methodologies meaningful and acceptable to the private insurance market. The LAN’s Guiding Committee convened the Alternative Payment Models Framework and Progress Tracking (APM FPT) Work Group (the “Work Group”) to bring together public and private stakeholders to assess APMs in use across the nation and to define terms and concepts essential for understanding, categorizing, and measuring APMs. The Work Group published the APM Framework White Paper in January 2016.
Building on the APM Framework, the Work Group also established the LAN Payer Collaborative to bring together industry leaders of both public and private payers to inform the LAN’s approach for applying the APM Framework and measuring APM adoption. In mid-February, the Payer Collaborative launched a five-week pilot to determine the feasibility of obtaining internal data from payers and to understand the investment of time and resources needed to complete the data collection. By refining the methodology through the pilot, the LAN has made every effort to decrease the burden associated with this request by developing clear measurement definitions and sharing the proposed collection instruments for each line of business publicly for comment and refinement.
The Request
To gain an accurate picture of APM adoption nationwide, the LAN is seeking to recruit 200–300 public and private health plans nationwide to join the health plans of the Payer Collaborative that have already joined the LAN and HHS in this critical APM data collection effort. Those who participate will help to advance understanding of the current state of payment innovation, and provide insights to advance effective payment reform for the future. Participating payers will be asked to report on spending in any or all of their commercial, Medicaid, or Medicare Advantage lines of business. Using the LAN’s collection tool (link below), payers will categorize their payments to providers in accordance with the APM Framework and share that categorized data with the LAN for it to be aggregated with data from other payers. Individual plan data will be kept strictly confidential.
The LAN’s methodology was developed and refined with the help of nine leading health plans who joined a pilot in the spring. By incorporating feedback from the pilot, the LAN developed clear measurement definitions and has made every effort to decrease the burden associated with this request. The plans participating in the pilot told the LAN that they found the process useful for understanding their own progress toward APM adoption and identifying opportunities for further expansion.
Participating payers will report on spending in categories 1-4 and subcategories for calendar year 2015, and categories 3 & 4 and subcategories for a 2016 point-in-time estimate (similar to CMS’ announcement). The LAN will work with all plans to help them categorize their spending, including those plans concerned about reporting to this level of detail. The LAN will endeavor to be flexible in order to allow for the greatest degree of inclusion possible that will produce a meaningful national metric.
The LAN has aligned its survey methodology with both public and private partners to ensure that participation at either level not only supports the LAN, but also prepares payers for future reporting requests. For instance, CMS will require MA plans to report on the proportion of payments made to providers using the same four categories of value based payment as the LAN framework. The LAN has also partnered with America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) to align with their survey to members.
For more detailed information on what the LAN intends to collect from payers who agree to participate in this national effort, please review the content within the links below:
Links to the excel files/collection tools for Medicaid, Medicare Advantage, and commercial lines of business
As a reminder, this 8-week quantitative data survey will run from May 18 – July 8, 2016. Payers who are interested in participating in this APM collection effort, can send an email to anne.gauthier.lan@mitre.org.
For additional information on the proposed metrics, please contact Andréa Caballero at acaballero@catalyzepaymentreform.org or (714) 815-8425.
The LAN is also interested in receiving ongoing feedback on this national APM data collection effort to improve our approach and to ensure that it is properly standardized and nationally accepted. Please submit comments and feedback by sending an email to anne.gauthier.lan@mitre.org
Please note this document may be updated and improved periodically based on feedback from health plans and other stakeholders.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Alex Billioux |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |