APM group sets targets for new payment models for healthcare

The Health Care Payment Learning and Action Network has issued a call for 30 percent use of APMs by next year in Medicare Advantage plans.

The Health Care Payment Learning and Action Network has issued a call for 30 percent use of alternative payment models by next year in Medicare Advantage plans.

The goals of the Learning and Action Network (LAN)—a group of private and public-sector healthcare leaders dedicated to accelerating the adoption of alternative payment models (APMs)— issued at the 2019 LAN Summit last week in Washington, also call for traditional Medicare to shoot for 30 percent APM by next year. The LAN is calling for both MA and traditional Medicare to have 50 percent of its payment models in APM by 2022 and 100 percent by 2025.

The LAN also recommends Medicaid plans and commercial health payers use APMs for 15 percent of their payment models by next year, 25 percent by 2022 and 50 percent by 2025.

The LAN’s goals follow the release of its fourth annual APM survey, which found that 91 percent of payers believe APM activity will increase. Participating in this year’s survey, taken in June and July, were 62 health plans, seven fee-for-service Medicaid states and traditional Medicare. The participants represent approximately 226.5 million of the nation’s covered lives and 77 percent of the national market, according to the LAN.

This year’s LAN APM report was also based on data from the Blue Cross Blue Shield Association and America’s Health Insurance Plans.

Alan Levine, chairman and CEO of Ballad Health, an integrated healthcare delivery system, says his organization supports LAN’s new goals as it moves into its next phase of transforming payment reform. “We believe that adoption of these goals is essential to improving cost, quality, and health equity objectives in support of value-based, person-centered care,” he says.

In August, Levine participated in the LAN CEO Forum in McLean, Va., where executives and clinical leaders discussed different ways to advance payment models that reward providers for quality and value of care. Some of the focus areas identified during the CEO Forum included addressing social determinants of health; reducing ineffective care and utilization; increasing data transparency and improving analytic capabilities; adopting enhanced technology; facilitating market-based solutions; and implementing new population-based approaches.

“With the right payment incentives in place, we know we can accomplish the new goals for the future of payment reform released by the LAN,” says Susan DeVore, CEO of Premier, another member of LAN’s CEO Forum.

Premier believes that to reach the goals of the LAN, all providers of care need to be incentivized to participate, from primary through to post-acute care. However, this can only happen if all the providers along the value chain are given equitable treatment across the various payment models to create a level playing field, DeVore says.

Premier also strongly supports the LAN’s goals to increase transparency, interoperability and timely access to data, she says, adding, “We are confident that these steps will help accelerate the movement toward new partnerships and collaboration in healthcare delivery, higher-quality care and the improved health of our nation.”

Download a copy of the new LAN report here .

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