1 There may be a more recent version of the Reference Guide on the TCPi Portal. Please refer to most updated version of the guide before disseminating information.

• Not prepared for, or tolerant of, negative risk

• Limited access to APMs based on specialty or geographic options

• Clinicians joining Medicare AAPMs would have to dis-enroll from TCPI, causing a disincentive to join an APM until later in the TCPI model test

Clinician reported- Barriers to Joining an APM

The CMS Value Statement

CMMI References

• CMS Innovation Center (CMMI): https://innovation.cms.gov

• Look under 2019 Milestones & Updates for a “fact sheet” on Physician-Focused Payment Models (pfpms).

• Posted on 4 Jan 2019: https://innovation.cms.gov/pfpms

• In the “additional information” section, there is a “Fact Sheet” in pdf format called: “Value Considerations for Model Development & Testing Fact Sheet”

5 There may be a more recent version of the Reference Guide on the TCPi Portal. Please refer to most updated version of the guide before disseminating information.

HCP LAN APM Measurement Effort

All-Payer Combination Option under QPP

• See the Quality Payment Program Website: qpp.cms.gov

• Look under the “APM Tab”

7 There may be a more recent version of the Reference Guide on the TCPi Portal. Please refer to most updated version of the guide before disseminating information.

From our last time together (2016)

Appendix

8

Weaknesses of Fee for Service Payment

Excessive use of

low-value services

Insufficient

incentives to

improve quality

of care

Poor coordination

of care

9

Payment Taxonomy Framework

Category 1:

Fee for Service

-No Link to

Quality

Category 2:

Fee for Service -

Link to Quality

Category 3:

Alternative Payment Models

Built on Fee-for-Service

Architecture

Category 4:

Population-Based

Payment

Med

icare

FFS

Limited in

Medicare fee-

for-service

Majority of

Medicare

payments now

are linked to

quality

Hospital value-based

purchasing

Physician Value-Based

Modifier

Readmissions/Hospital

Acquired Condition

Reduction Program

Accountable care organizations

Medical homes

Bundled payments

Comprehensive primary care

initiative

Comprehensive ESRD

Medicare-Medicaid Financial

Alignment Initiative Fee-For-

Service Model

Eligible Pioneer

accountable care

organizations in years 3-5

Payment Taxonomy Framework

10

We need to learn our way

into a better system,

together.

11

Accountable Health Communities Model--AHCM

• Announced by HHS on 5 January 2016

• Can find it on www.hhs.gov in “News” section

• $157M in grant awards for up to 44 Programs

• Focused on addressing the social needs of

patients, tests if we address: • Housing instability

• Food insecurity

• Transportation limitations

• Interpersonal violence

• Do we improve the quality and effectiveness of the Medicare

and Medicaid Programs?

https://innovation.cms.gov/initiatives/ahcm

12

Accountable Health Communities Model--AHCM

“We recognize that keeping people healthy is about more than what

happens inside a doctor’s office, and that’s why, for the first time, we

are testing whether screening patients for health-related social needs

and connecting them to local community resources like housing and

transportation to the doctor will ultimately improve their health and

reduce cost to taxpayers.”

Clinical Practice Improvement Activities

13

The Secretary is required to specify clinical practice improvement activities. Subcategories of activities are also specified in the statute, some of which are:

Secretary shall solicit suggestions from stakeholders to identify activities. Sec. retains discretion. Secretary shall give consideration to practices <15 EPs, rural practices, & EPs in under served areas.

Other MIPS/APM Provisions

Additional MIPS/APM provisions require the Secretary to: • Engage the physician and eligible professional

community to develop care episode groups, patient condition groups, and patient relationship categories.

• Provide technical assistance to small practices in rural areas, health professional shortage areas, and medically underserved areas with respect to the MIPS performance categories and to help practices transition to APMs.

References

• MACRA Legislation: https://www.govtrack.us/congress/bills/114/hr2

• Congressional Research Service Review of MACRA: https://www.fas.org/sgp/crs/misc/R43962.pdf

• MACRA and MIPS on CMS.gov:

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html

15

January 12, 2016

APM Framework White Paper

For Public Release

A Comment Summary is also accessible

The final APM Framework White Paper may be viewed at:

www.hcp-lan.org

The final version of the White Paper reflects LAN participant comments, as appropriate, and is a much

stronger document because of them.

Final APM Framework White Paper

17

For Public Release

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 is to shift U.S. health care spending significantly towards population-based payments.

Value-based incentives should ideally reach the providers who deliver care.

Payment models that do not take quality into account will be classified within the appropriate category and marked with an "N" to indicate "No Quality" and will 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 in the Framework, rather than categories, because they are delivery systems that can be applied to and supported by a variety of payment models..

APM Framework Summary of Key Principles

12