The Health Care Payment Learning Action Network‘s Alternative Payment Model Framework and Progress Monitoring Work Group has released its finalized White Paper/framework on alternative payment models (APMs). This framework will be considered by the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA), which will establish new formulas for Medicare payments to physicians that include alternative payment models. The framework also will provide options for the Department of Health and Human Services (HHS) to achieve its 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. A draft of the framework was released for discussion and comment in October 2015.
The framework rests on seven principles:
- Changing providers’ financial incentives is not sufficient to achieve person centered care, so it will be essential to empower patients to be partners in health care transformation.
- The goal for payment reform is to shift U.S. health care spending significantly towards population based (and more person focused) payments.
- Value based incentives should ideally reach the providers that deliver care.
- Payment models that do not take quality into account are not considered APMs in the APM framework, and do not count as progress toward payment reform.
- Value based incentives should be intense enough to motivate providers to invest in and adopt new approaches to care delivery.
- APMs will be classified according to the dominant form of payment when more than one type of payment is used.
- Centers of excellence, accountable care organizations, and patient centered medical homes are examples, rather than Categories, in the APM Framework because they are delivery systems that can be applied to and supported by a variety of payment models.
The Framework has four categories to move away from the current fee-for-service model towards values-based payments:
In addition, although the Work Group was not charged with developing a definition of person centered care, it thought that it was important to do so because it views payment reform as one means for accomplishing the larger goal of person centered care. The Work Group believes that person centered care rests on three pillars: quality, cost effectiveness, and patient engagement. For the purposes of the White Paper, the term is defined as: high quality care that is both evidence based and delivered in an efficient manner, and where patients’ and caregivers’ individual preferences, needs, and values are paramount.