1. Health Care Payment Learning and Action Network: Alternative Payment Methods Framework and Measurement
Presented to Minnesota Health Action Group
December 2015
Julie Sonier
Director, State Employee Group Insurance Program
Minnesota Management and Budget

2. Health Care Payment Learning and Action Network (HCP LAN)
Accelerate the health care system’s transition to alternative payment models (APMs) by combining the innovation, power, and reach of the public and private sectors. Goals: 30% of U.S. payments by 2016, 50% by 2018.
Develop a framework for categorizing APMs and an approach to measuring adoption of APMs
Clinical episodes payment (bundled payments)
Population-based payment
Alternative Payment Models Framework and Progress Tracking Workgroup
Other HCP LAN Workgroups
For More Information

3. APM Framework and Progress Tracking Workgroup Membership
Physicians/Health Care Providers
Private Payers
CMS
Consumer Groups
Employers
State Government

4. Seven Key Work Group Principles
It’s not just about payment strategies – patient engagement is also key.
The goal is to drive change toward models with greater accountability for quality and value.
Incentives should flow through to individual providers to the extent possible.
The link between payment and quality is essential.
Incentives must be large enough to be meaningful.
Hybrid approaches should be categorized using the dominant model.
There is an important distinction between delivery models and payment models. 1 2 3 4 5 6 7

5. Workgroup’s Draft Framework Categories
Category 1:
Fee for service, no link to quality
Category 2: Fee for service, link to quality
2A: Payments for infrastructure/ operations
2B: Pay for reporting
2C: Rewards for performance
2D: Rewards and penalties for performance
Category 3: APMs Built on Fee for Service Architecture*
3A: APMs with upside risk
3B: APMs with upside and downside risk
Category 4: Population-Based Payment*
4A: Limited Population-based payments
4B: Comprehensive population-based payments
*Additional category denoted “3N” or “4N” for payment models with no link to quality.
October 2015 draft white paper is available at:

6. How Might Employers Use the Framework?
Accountability/reporting from health plans and third-party administrators
Direct contracting with providers
Use purchasing leverage to drive the market
Employers/purchasers have important roles to play in multi-stakeholder efforts
Multi-stakeholder efforts to improve health care & health outcomes
Measurement methodology still in development
SEGIP is building similar concepts into its administrative services contracts to better understand current practices & set goals/strategies for the future
Prevalence of APMs
Intensity of incentives and what quality measures they are tied to
Measure progress over time toward goals

7. White paper released in late October for public comment
Workgroup Status
White paper released in late October for public comment
Currently incorporating comments into a revised white paper/framework
Anticipated release of final paper: January 2016
Measurement framework being developed simultaneously
Data collection from payers in early 2016