The Health Care Payment and Learning Action Network (HCPLAN) recently held its first summit in Washington, D.C.  I joined about 250 healthcare industry leaders at this event, which demonstrated that this group will play a significant role in shaping health care’s transition from fee-for-service to value-based-care models.

The U.S. Department of Health and Human Services (HHS) created the HCPLAN earlier this year towards the goal of moving 30% of Medicare reimbursements to alternative payment models in 2016 and 50% by 2018. Through the HCPLAN, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs.

Two of the main topics at the summit were the Alternative Payment Model (APM) Framework and Medicare Access and Chip Re-authorization Act (MACRA). Here’s a summary of key points in each of those areas:

1) The Alternative Payment Framework and Progress Tracking (APM FPT) Work Group recently published the APM Framework White Paper. While generally supportive of the framework and the work being done, attendees called for clarification in certain areas, including:

  • Clearly distinguish between delivery models and payment models. Right now they are often mixed despite meaning different things to providers, patients and software developers.
  • Identify and document the likely required investment to prepare for and become part of an APM. The provider communities will need a clearer understanding of the return on investment (ROI) to address concerns about upfront investment.
  • Address the lack of reporting, quality measure and practice transformation requirement standards across many of the existing alternative payment models.

2) Patrick Conway, Deputy Administrator for Innovation & Quality, CMS Chief Medical Officer, and Mai Pham, CMS Innovation Center Chief Innovation Officer, reviewed the Medicare Access and Chip Re-authorization Act (MACRA). Commonly referred to as the SGR repeal bill, the MACRA was signed into law in April and introduced significant changes to the physician reimbursement model. Key learnings included:

  • The law was structured to speed the transition to value-based care.
  • The Value Based Modifier, PQRS, and MU programs will sunset in 2018 and become part of the new Merit-Based Incentive Payments System (MIPS).
  • Bonus payments will be available to providers that participate in eligible alternative payment models (APMs).
  • The law removed penalties from the MU program for EPs starting in 2018.
  • The new payment models will take effect in 2019, but payment adjustments will be based on prior years’ performance.
  • CMS gathered feedback through November 17, 2015; the proposed rule is expected in early spring 2016 and the final rule in early fall of 2016.

The wide engagement by stakeholders who attended the meeting from across the industry demonstrates that the HCPLAN will have a significant impact in shaping industry and CMS models moving forward. Allscripts will continue to be an active participant in the HCPLAN to represent our clients as the industry moves to value-based care.

If you’d like help managing the transition to value-based care, contact consultingservices@allscripts.com.

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About the author

Matthew Fusan is a Strategic Sales Consultant at Allscripts. In this role he is focused on clients’ transition from fee-for-service to value-based care, develops solutions and provides strategic guidance to help clients succeed with alternative payment models and population health management. Prior to this role, Matthew was part of the Allscripts Regulatory Team providing guidance as Allscripts prepared products and services for new opportunities and challenges based on the transition to value-based care. Prior to Allscripts, Matthew held a variety of program management and delivery leadership positions at Blue Cross and Blue Shield of North Carolina and Highmark Blue Cross and Blue Shield. Matthew has more than 15 years of experience in the healthcare industry and holds a Bachelor of Science degree from Penn State University.

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