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Date/Time
Date(s) - Thursday, August 27, 2015, 8:00 AM - 4:00 PM

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MITRE Corporation


Objectives for the Meeting

  • Get to know each other and establish our working relationship
  • Gain consensus on how the work group will operate and collect feedback on the draft charter
  • Collaboratively build an APM Framework using the CMS Framework as a starting point
  • Introduce measurement framework and progress tracking approach

Agenda

  • Welcome, Introductions and Meeting Overview – Sam Nussbaum, Anne Gauthier
  • Work Group Charter and Operating Norms – Sam Nussbaum, Jamel Morris
    • Charter review
    • Roles of CAMH and Guiding Committee
    • Meeting frequency
  • Mapping of Payment Models to Baseline Framework – Sam Nussbaum, Von Nguyen, Grischa Metlay
    • Review CMS Framework assumptions
    • Map existing payment models to baseline framework
    • Identify orphan models and determine how framework should be adapted to accommodate these models
  • Building the APM Framework – Sam Nussbaum
    • Intensity of value-based incentives
    • Quality metrics and payment determinations
    • Consistent approaches to cost measures and benchmarking
  • Review of Framework Categories – Sam Nussbaum
    • Review definition of each category and the lines of demarcation between them
  • Measurement and Progress Tracking Effort – Andrea Caballero
    • Provide overview of the measurement framework and progress tracking effort
    • Discuss current methodologies used and they might be applicable or beneficial to the work of this group
  • Next Steps and Wrap-Up – Sam Nussbaum, Anne Gauthier, Jamel Morris
    • Recap agreements on next steps for each session
    • Review and refine delivery timeline
    • Plan for sharing meeting notes and summary
    • Review key upcoming LAN events
    • Review logistics for next work group meetings
    • Collect meeting feedback

Summary

The APM Framework and Progress Tracking Work Group met for the first time in person on August 27 in McLean, Virginia. The day-long meeting focused on the group’s first objective of developing and proposing a framework for categorizing APMs. The group discussed leveraging the categorization framework developed by CMS as a baseline and identified potential refinements. Additional considerations were raised around whether to recommend approaches to linking payment decisions to performance on quality metrics, whether to recommend approaches to cost measurement, and how the framework should account for the intensity of incentive payments. In the coming months, the group will reach out to LAN participants for comments and suggestions on a draft white paper detailing its recommended framework.

The group also discussed methodologies currently used for measurement and tracking of payment reform and identified factors to consider when proposing a methodology and process for tracking the progress of APM adoption across the U.S. health care system. Factors discussed include how stringently the data should be validated, whether tracking should be conducted in terms of patients, providers, and dollars associated with APM, how to avoid double-counting members participating in an APM, and how frequently plans and providers will be asked to report data. The next in-person group meeting will be in the Washington, D.C., area this fall. A full summary of the August 27 meeting will be posted online in the near term.

Download Full Summary

To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume. The Health Care Payment Learning and Action Network (LAN) was established as a collaborative network of public and private stakeholders, including health plans, providers, patients, employers, consumers, states, federal agencies, and other partners within the health care community.

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