The Centers for Medicare and Medicaid Services launched the Health Care Payment Learning and Action Network in March 2015 to increase the adoption of value-based payments and alternative payment models. The Department of Health and Human Services (HHS) has set a goal of tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models (APMs) by 2016, and to increase that to 50 percent by 2018. HHS also has set a goal of tying 85 percent of all Medicare fee-for-service to quality or value measures by 2016, and to increase that to 90 percent by 2018.
In addition, under the Medicare Access and CHIP Reauthorization Act (MACRA), which repealed the Sustainable Growth Rate (SGR) payment schedule for Medicare physician payments, after 2019, physicians will only receive increases in their fee-for-service Medicare payments through either a Merit-Based Incentive Payment System (MIPS) or alternate payment models (APMs).
The Health Care Payment Learning and Action Network will:
- Serve as a convening body to facilitate joint implementation of new models of payment and care delivery,
- Identify areas of agreement around movement toward alternative payment models and how best to analyze data and report on these new payment models,
- Collaborate to generate evidence, share approaches, and remove barriers,
- Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, quality and performance measurement, risk adjustment, and other topics raised for discussion, and
- Create implementation guides for payers, purchasers, providers, and consumers.
All payers, providers, employers, states, consumer groups, individual consumers, and others are invited to participate. Participants will have the opportunity to join workgroups and learning sessions on increasing adoption of alternative payment models and other care delivery models. Most meetings of the network will occur virtually by teleconference or webinar. In-person meetings will occur in the Washington D.C. area. As of May 2015, there were over 600 organizations that have agreed to participate in the network’s activities, with another 3,400 organizations and individuals signed up for network updates:
The CMS Alliance to Modernize Healthcare (CAMH), operated by The MITRE Corporation, has convened a Guiding Committee to provide executive leadership for the Health Care Payment Learning and Action Network. The 24 Guiding Committee members are influential leaders in their fields. They represent diverse stakeholder groups, including providers, health plans, purchasers, employers, consumers, patients, and state, regional, and federal representatives.
The network’s first work group, the Alternate Payment Model Framework and Progress Tracking Work Group, was launched in July 2015 and is focused on developing common payment reform terms and operational definitions. Here are the members of the work group: