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Date/Time
Date(s) - Monday, November 16, 2015, 8:30 AM - 4:00 PM

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Location
MITRE Corporation


Objectives for the Meeting

  • Review the purpose and principles of the Work Group (WG), Guiding Committee (GC), and Alternative Payment Model (APM) framework
  • Discuss and provide recommendations on the development of episode design and sprint operations

Agenda

  • Welcome and Opening Comments – Lew Sandy, Anne Gauthier
    • Review meeting objectives and agenda
    • Review high-level WG purpose and GC principles
  • LAN APM Framework: Our Common Language – Glenn Steele
    • Review APM framework and principles
  • Operating Norms and WG Charge – Anne Gauthier, Lew Sandy
    • Review operating norms and WG charge
    • Finalize conditions for Sprints #2 and #3
    • Discuss products and timeframes
  • High Level Episode Design and Operations: Joint Replacement as a Case Study – Karen Milgate, Lew Sandy
    • Review research and lay out episode design and operational elements for sprint discussion
  • Working Session: Develop Preliminary Recommendations on the Joint Replacement Episode Sprint- Tanya Alteras, Karen Milgate
    • Episode Design
    • Operations
  • Sprint Report Outs – Work Group Members
  • Next Steps and Wrap Up – Lew Sandy, Anne Gauthier
    • Discuss road map for moving forward on Sprint #1 work product
    • Summarize feedback
    • Wrap up

Summary

At its first in-person meeting, held on Monday, November 16, the CEP Work Group kicked-off its efforts, bringing together payers, providers, states, and consumer advocates to advance the deployment of effective clinical episode-based payment models that drive and support better health outcomes for patients at a lower cost. The work group came to consensus on its charge: to identify payment strategies and align innovations within and across the private sectors. Members also came to consensus on the subjects of its three episode sprints: 1) Total Hip Replacement (for patients with osteoarthritis and/or fracture) and Total Knee Replacement (for patients with osteoarthritis); 2) Maternity Care; and 3) Cardiac Care. For each of these episodes, the work group will consider the following design elements from the perspective of how to elicit the optimal outcome for the patient:

  • The start point and length of each episode;
  • The relative levels of accountability and risk involved;
  • Strategies for establishing target price and benchmarks;
  • Appropriate quality metrics (including both clinical quality and patient-reported measures); and
  • The data systems that would be needed to eventually bring episode payment to scale across multiple payer and provider types.

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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