The Department of Health and Human Services (HHS) launched the Health Care Payment and Learning and Action Network (LAN) in 2015 to align stakeholders across sectors in moving payment from traditional fee-for-service (FFS) methods to one linked to quality via alternative payment models (APMs). The LAN is an unprecedented collaboration of stakeholders from the private, public, and non-profit sectors whose goal is to transform the nation’s health system by supporting health care value over volume. Both employers and their employees can benefit from improved care and reduced costs, but are more likely to see improvements if they join this initiative and play an active role in shaping the journey toward value-based care.
The LAN has documented national progress toward value-based payment. HHS Secretary Burwell recently announced the release of a LAN report that measured progress in the adoption of APMs in 26 commercial, 23 Medicare Advantage and 28 Medicaid health plans and 2 States - representing a total of 128 million Americans or nearly 44% of the covered population in those segments. For the 2016 look-ahead results, 25% of payments are estimated to flow through APMs either using two-sided risk built on fee-for-service architecture or through defined budget population-based payments. The results of the LAN’s study establish a benchmark against which future progress can be measured.
Additionally, the LAN’s Primary Care Payment Model (PCPM) Work Group recently released a set of guiding principles and recommendations that create a foundation for designing and implementing APMs that support primary care. The recommendations envision PCPMs as a catalyst to promote better care, smarter spending, and healthier people, and outline a set of actions that can be taken to achieve this goal. The recommendations emphasize maintaining flexibility within payment models to acknowledge variation in practice size, ownership, and location, including those in rural areas with limited staff. The set of guiding principles also answer questions like “What can PCPMs do to enable better integration between primary care and behavioral health?”