Fact Sheet: Health Care Payment Learning and Action Network
Fact Sheet: Health Care Payment Learning and Action Network
Working Together to Move Payment toward Value and Quality in the U.S. Health System
Updated March 25, 2015
Historically, health care providers have been paid based on the quantity of care they give patients, with each x-ray, test, procedure, or doctor’s visit – whether needed or not – bringing in more money. For example, the doctor who properly diagnosed high blood pressure on the patient’s first visit and prescribed the correct medication was paid less than the doctor who misdiagnosed the patient, resulting in the patient having to come back in for follow-up visits to get the proper diagnosis. This model inadvertently encourages more and more tests, and poor coordination of patient’s care, rewarding health care providers for the quantity, instead of the quality of care they gave. As a result, patients often haven’t received the coordinated care they need and instead often have to get even more costly care down the line.
To change these practices and improve the quality of care patients get when they go to the doctor, the Affordable Care Act created a number of new payment models that move the needle further toward paying health care providers for the quality of the care they give patients, instead of the quantity of care. In these alternative payment models, providers have a financial incentive to coordinate care for their patients and get the right care to the right patient the first time.
In the past five years since the Affordable Care Act became law, progress has been made. More than 400 Medicare ACOs participating in the Shared Savings Program and the Pioneer ACO Model have generated a combined $417 million in savings for Medicare. The Affordable Care Act has also helped improve the quality of health care, contributing to 50,000 fewer patient deaths in hospitals due to avoidable harms, like an infection or medication error, and 150,000 fewer preventable Medicare hospital readmissions.
To build on this success, HHS is engaging public and private payers, purchasers, providers, consumers, and states to move together toward successful payment models that improve health care quality. Engagement with state Medicaid programs and commercial payers can reduce costs for providers and accelerate progress. Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced an ambitious initiative supported by the Affordable Care Act to continue to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity, of care they give patients.
The Purpose of the Health Care Payment Learning and Action Network
The Health Care Payment Learning and Action Network is a key component of this effort to deliver better care, smarter spending of health dollars, and healthier people.
The Health Care Payment Learning and Action Network (“Network”) is being established to provide a forum for public-private partnerships to help the U.S. health care payment system meet or exceed recently established Medicare goals for value-based payments and alternative payment models. These goals are to move 30 percent of Medicare payments into alternative payment models by the end of 2016 and 50 percent into alternative payment models by the end of 2018. Alternative payment models include models such as Accountable Care Organizations (ACOs), bundled payments, and advanced primary care medical homes.
The Network will serve as a forum where payers, providers, employers, purchasers, states, consumer groups, individual consumers, and others can discuss, track, and share best practices on how to transition towards alternative payment models that emphasize value. The Network will be supported by an independent contractor that will act as a convener and facilitator.
- As a convener, the Network contractor will bring together Network participants in a variety of contexts (large meetings, webinars, and working groups) to spread best practices and decrease unneeded variation in payment methodologies.
- As a facilitator, the Network contractor will provide support to a guiding committee and workgroups that will generate priorities and create summary papers. The contractor will maintain the pace of the Network so that it readily addresses the needs of participants.
Open Invitation to Participate in the Health Care Payment Learning and Action Network
All payers, providers, employers, purchasers, states, consumer groups, individual consumers, and others can participate in the Health Care Payment Learning and Action Network. All interested individuals and organizations are invited to register at innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/.
Management of the Health Care Payment Learning and Action Network
The Network will be convened by an independent contractor funded by the Centers for Medicare & Medicaid Services (CMS). The Network management team will convene meetings, disseminate information to Network participants, and lead learning sessions where participants can share best practices. The Network management team will consider the views and recommendations of the Network when performing activities. The Network management will operate independently of HHS, CMS, and other government entities to be an unbiased source of support for the efforts of the all participants.
A Guiding Committee will be created to prioritize discussion topics and make recommendations to the management team. Participants of this Guiding Committee will be drawn from participants in the Network. Workgroups will be created by the independent contractor in consultation with the Guiding Committee to address specific topic areas. Participants in workgroups will also be drawn from Network participants. Representatives from HHS can participate equally on the Guiding Committee and workgroups. Information will be shared with the entire Network through regularly scheduled webinars and in-person meetings. MITRE has been selected as the independent contractor for the Network.
Meetings of the Health Care Payment Learning and Action Network
Most meetings of the Network will occur virtually by teleconference or webinar. In-person meetings will occur in the Washington, D.C. area. The frequency of meetings will be determined by the Network management team and informed by the Guiding Committee. CMS anticipates that there will be at least one meeting of the full Network each year, with additional webinars and discussions as needed. The Guiding Committee and workgroups will meet more frequently depending on the topics under discussion.
Activities of the Health Care Learning and Action Network
Workgroup discussion topics will be defined by the independent management team in consultation with the Guiding Committee and Network participants.
The Health Care Payment Learning and Action Network will perform the following functions:
- 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 define how best to 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.
Participating in the Health Care Payment Learning and Action Network
Participants will be expected to actively engage in the Network by contributing to workgroups, sharing best practices, and learning from peers.
Stakeholders participating in the Network will be asked to:
- Support national alternative payment model goals for the U.S. health system that match or exceed the Medicare fee-for-service goals (30% alternative payment model penetration by 2016 and 50% by 2018),
- Agree that progress towards national goals should be measured, and
- Work with Network participants to establish standard definitions for alternative payment models.
Within the first six months, stakeholders will be asked to
- Set organization-specific goals for alternative payment models, and
- Participate in reporting of progress towards national alternative payment model goals.
Dissemination of Findings for the Health Care Payment Learning and Action Network
The Network management team will synthesize and document best practices across a variety of topic areas. Workgroups will be responsible for sharing their findings with the contractor to produce ‘best practice’ white papers. These best practices will inform webinar and in-person meetings where lessons learned will be shared. The frequency of reports and learning sessions will depend upon the topics.
We anticipate that the Network management team will build a repository of best practice papers for participants and the general public. When payers, providers, employers, purchasers, states, consumer groups, or individual consumers want to enter into alternative payment contracts or want to learn more about alternative payment models, they will be able to quickly obtain detailed information about best practices and to identify experts who are willing to share their experiences.
There is no fee to participate in the Network. Organizations will not receive funding from HHS or CMS for participating in the Network. Travel and accommodation for in-person meetings will not be paid for by HHS or CMS.
How to Register for the Health Care Payment Learning and Action Network
You can register at innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/. After you register, you will receive regular updates through the Network listserv. The names of registered organizations will be made public.