New digital tool offers payers a road map to alternative payment models 

hospital money
A new Learning & Action Network tool offers best practices for adopting new payment models. (Getty/PraewBlackWhile)

The Health Care Payment Learning & Action Network has launched a new guide aimed at smoothing the bumpy road to adopting new payment models. 

The group’s new Roadmap for Driving High Performance in Alternative Models is an interactive tool for payers to explore best practices for these models. The tool is built from four years of Learning & Action Network (LAN) research on alternative payment models (APMs) along with interviews with 22 payers and providers working in 10 such models on their paths to value-based care.  

Mark McClellan, M.D., director of the Duke Margolis Center for Health Policy and co-chair of LAN’s guiding committee, told FierceHealthcare the group had, to date, mostly focused on the basics of payment reform, and building the road map allowed it to synthesize that work into a more “systematic approach.”

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“There’s more adoption of new payment models—the momentum and the pace seem to be increasing—but it still seems slow compared to what we’d like to see,” McClellan said. 

RELATED: The challenge of designing new payment models for prescription drugs 

The road map is built on three key themes—payment model design, payer-provider collaboration and patient-centeredness—that include strategies on quality measurement, data sharing, patient engagement and benchmarking. 

For example, LAN found a growing interest in developing multipayer models, which require strong leadership both within the organizations themselves and from policymakers and other stakeholders. Some insurers are also forming provider advisory boards or joint operating committees when designing new payment systems. 

Other best practices include: 

  • Putting a spotlight on health literacy to better include patients in the design process
  • Integrating benefit design with APMs to push members toward high-quality, low-cost providers
  • Building a data-sharing model with a timeline that’s appropriate for individual providers and how they use such information
  • Designing models that support providers in a more gradual move toward increased risk

RELATED: More providers adopting value-based payment models, but plenty still hesitate to take on risk 

However, although experience has offered plenty of lessons for insurers on moving toward value-based models, there are still challenges, LAN notes. The tool offers both immediate and long-term strategies payers can use to address these issues. 

Quality measurement, for example, remains a barrier, as there’s a dearth of measures to track quality-of-life outcomes and the social determinants of health. Up front, payers can do more to build existing patient experience measures into new payment models, while continuing to push for the development of new measures to more effectively capture these trends in the long-term, LAN recommends. 

However, LAN views the tool as an evolving one and is looking to continue gathering feedback and data to further build on existing resources, McClellan said. 

“I think it’s important to keep in mind that this is an important step in dynamic and ongoing process,” McClellan said. 

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