For Public Release Patient Attribution & Financial Benchmarking for Population-Based Payment Models LAN Update Webinar February 09, :00 1:30 pm EST For Public Release Welcome Anne Gauthier LAN Project Leader, CMS Alliance to Modernize Healthcare (CAMH) For Public Release Session Objectives Learn: Understand the PBP Work Group recommendations on Patient Attribution and Financial Benchmarking Identify barriers to payer and provider alignment on patient attribution and financial benchmarking methodologies Engage: Ask your questions Provide your comments to the recommendations on the draft White Papers Prepare to submit written comments on the papers For Public Release Agenda Time (ET)Topic 12:00 12:05 pm Opening Remarks 12:05 12:20 pm Guiding Committee Report, with Q & A 12:20 12:55 pm PANEL: Patient Attribution & Financial Benchmarking 12:55 1:25 pm Questions from LAN Participants 1:25 1:30 pm Upcoming LAN Activities and Closing Comments For Public Release Poll Who is in the audience? Provider Consumer/Patient Commercial Insurer Private Employer State Government Federal Government Research Health Expert/Consultant Other For Public Release Guiding Committee Welcome Elizabeth Mitchell Member, LAN Guiding Committee President and CEO, Network for Regional Healthcare Improvement (NHRI) For Public Release Goals % In 2016, at least 30% of U.S. health care payments are linked to quality and value through APMs % In 2018, at least 50% of U.S. health care payments are so linked. Adoption of Alternative Payment Models (APMs) % % Better Care, Smarter Spending, Healthier People These payment reforms are expected to demonstrate better outcomes and lower costs for patients. For Public Release The LAN has Established 7 Groups with Varying Purposes LAN Guiding Committee Purchaser Network APM Framework & Progress Tracking Work Group Payer Collaborative Clinical Episode Payment (CEP) Work Group Population-Based Payment (PBP) Work Group Consumer and Patient Affinity Group State Engagement Group APM Framework Key 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 is to shift U.S. health care spending significantly towards population-based payments. Value-based incentives should ideally reach the providers who deliver care. Value-based incentives should be intense enough to motivate providers to invest in and adopt new approaches to care delivery. For Public Release Using the APM Framework to Measure Adoption of Alternative Payment Models The LAN intends to use the APM Framework as a "gauge" for measuring progress towards adoption of APMs Payer Collaborative A diverse group of health plans assembled to inform the LAN's approach for measuring adoption of APMs Measurement Pilot A subset of Payer Collaborative participants will take part in an exercise to further inform and test the feasibility of the approach The resulting approach will be used to measure the nation's progress towards the goals of 30 percent adoption by 2016 and 50 percent adoption by 2018 For Public Release PBP and CEP Work Groups Population-Based Payment (PBP) Work Group Sprints Launched Patient Attribution Financial Benchmarking Performance Measurement Data Sharing Clinical Episode Payment (CEP) Work Group Sprints Launched Elective Hip and Knee Replacement Maternity Cardiac Care For Public Release LAN Communications Join work group affiliated communities to provide input on work group products Keep updated on the latest LAN info through our newsletter Visit the LAN website to learn more and find resourcesLAN website For Public Release Save the Date: LAN Summit Spring 2016 April 25 26, 2016, Sheraton Tysons, VA Call for Abstracts & Registration opening soon Updated information will be available on the LAN Summit website.LAN Summit website For Public Release Q & A What questions do you have about the Guiding Committee report? Use the chat window in your webinar dashboard For Public Release Poll What are the biggest barriers to adopting PBP models? Check all that apply Patient understanding of PBP model Different approaches to patient attribution in market Different approaches to financial benchmarking within the market Too many performance measures with slightly different definitions Operational issues associated with sharing data Capacity to make changes necessary to adopt the model Regulatory landscape Other: write in biggest barriers For Public Release Moderator: Patient Attribution & Financial Benchmarking Dana Gelb Safran, Sc.D. Chief Performance Measurement & Improvement Officer Senior Vice President, Enterprise Analytics, Blue Cross Blue Shield Massachusetts Population-Based Payment Work Group Leadership Dana Gelb Safran, ScD Chief Performance Measurement & Improvement Officer, Senior Vice President, Enterprise Analytics at Blue Cross Blue Shield of Massachusetts Glenn D. Steele Jr., MD, PhD Chairman of xG Health Solutions, an independently operated venture launched by Geisinger Health System Charge The work group will identify the most important elements of population- based payment models for which alignment across pubic and private payers could accelerate the adoption of these models nationally. APM Framework Work Group The LANs Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group was successful in developing a Framework for categorizing APMs. Within the APM framework, population- based-payment models fall into categories some of 3 and 4. For Public Release PBP Work Group Priority Areas Patient Attribution Patient attribution identifies the patient-provider relationship and forms the basis for performance measurement reporting and payment in a PBP model. Financial Benchmarking Financial benchmarks are set to help providers and payers to manage resources, plan investments in delivery support infrastructure, and identify inefficiencies. Data Sharing Data sharing refers to the exchange of information between payers and providers to successfully manage total cost of care, quality and outcomes for a patient population. Performance Measurement PBP models require a measurement system through which providers and payers monitor performance, and performance is rewarded. For Public Release Panelist: Patient Attribution Amy Nguyen Howell, MD Chief Medical Officer CAPG Why Attribution? Better health Choosing a primary care provider allows patients to receive the care they want Frequent follow up with patients allow primary care providers to get to know their patients health, and help them make better health related decisions It is a mechanism for creating accountability within a provider group to coordinate a patients overall care needs Patient Attribution Assumptions Patient attribution is a foundational component of population based payment, as it identifies the patient-provider relationship and forms the basis for performance measurement, reporting, and payment. Even though methods begin by identifying a patient-clinician dyad, recommendations use this information to attribute patient to the appropriate provider group/system for purposes of PBP models. The consensus guidelines are intended for use in payment models that involve provider accountability for care across the full continuum. Different attribution methods are required for episode-based models. The PBP work group suggests that the consensus guidelines should be generalizable for use across all commercial insurers, and should be evaluated for applicability to, government programs. Key Steps in Patient Attribution Patient Attribution Recommendations 1.Encourage patient choice of a primary care provider 2.Use a claims/encounter-based approach when patient attestation is not available 3.Define eligible providers at the beginning of the performance period 4.Provide transparent information to patients about their attribution 5.Prioritize primary care providers in claims/encounter-based attribution Patient Attribution Recommendations 6.Consider subspecialty providers if no primary care is evident 7.Use a single approach for attribution for performance measurement and financial accountability 8.Use the patient attribution guideline nationally for commercial products. 9.Alignment among commercial, Medicare, and Medicaid populations may be possible with adjustments. 10.Regardless of whether prospective or concurrent attribution is used, providers should receive clear, actionable information about patients attributed to them. For Public Release Panelist: Financial Benchmarking Michael E. Chernew, Ph.D. Leonard D. Schaeffer Professor of Health Care Policy Director of Healthcare Markets and Regulation Lab at the Department of Health Care Policy Harvard Medical School Financial Benchmarking Principles The purpose of financial benchmarks in PBP models is to enable accountability, compare performance across sites and over time, and to establish a target that fairly rewards high performers. Payers should transparently communicate to providers the risk-sharing parameters involved in participating in a PBP model. Unexpected events will require collaborative responses from purchasers, payers and providers. In such cases, trust between payers and providers must already exist to update methodologies in a way that is financially responsible and fair for providers. Why Financial Benchmarking? Financial benchmarks lead PBP models toward more high valued care Setting financial benchmarks help to ensure that overall spending remains at a sustainable level Using financial benchmarks to compare performance across provider organizations, helps to identify optimal spending levels Financial benchmarks provide a foundation for providers to deliver high quality, cost effective, and person centered care Financial benchmarks hold provider organizations accountable for delivering care efficiently Financial Benchmarking Assumptions Participation in PBP models will likely be voluntary in the vast majority of circumstances, but participation in PBP models should be driven in part by decreasing demand for FFS-based alternatives. Successful approaches to financial benchmarking must simultaneously encourage participation while meeting financial and quality objectives. The goal of financial benchmarks is to enable 1) efficient provider organizations to succeed; 2) struggling organizations to improve; and 3) failing organizations to fail. Financial Benchmarking Recommendations 1)Approaches to financial benchmarking should encourage participation in the early years of the models progression, while driving convergence across providers at different starting points towards efficiency in the latter years. a)The initial baseline should be based on provider-specific spending, taking into account the provider organizations history and local market forces. b)Updates to the initial baseline should quickly drive convergence around local spending rates, with an eventual movement to regional and national rates in the medium to long term. c)There are multiple pathways to convergence, but the end point is what matters. Financial Benchmarking Recommendations 2)Risk adjustment must strike a fine balance, such that providers who serve disadvantaged populations are not unduly penalized, and disadvantaged populations do not receive substandard care. a)The state of the art of risk adjustment is likely to change over time, and it will be important to keep up with recent developments that improve the precision of risk-adjustment approaches. b)Risk adjustment models should minimize the connection between utilization and risk, in part by increasing the time lag between when variables are coded and when adjustments are applied. Financial Benchmarking Recommendations c)Successful risk-adjustment models should accurately predict spending at the population and subpopulation, but it is not important for models to accurately predict spending at the individual level. d)PBP models should not disrupt care for high-need populations, and risk adjusting for socioeconomic status (SES) may be one way to accomplish this. Nevertheless, SES adjustments should not be a mechanism for forgiving lower care for needy populations. For Public Release Q & A What questions do you have about Patient Attribution & Financial Benchmarking recommendations? What changes or additions to these recommendations would you suggest that would help you implement PBPs in your market? What do you see as the most significant barriers to adopting these recommendations? What are the barriers to private and public payers to adopting the same methodologies? Use the chat window in your webinar dashboard For Public Release Key Upcoming Dates February 23, LAN Update Webinar Accelerating and Aligning Clinical Episode Payment Models: Preliminary Recommendations on Elective Joint Replacement February 24, LAN Learnings Webinar Value-Based Payment for Patients with Chronic Illness For Public Release Ask a questionRegister online Visit our siteorg org Get Involved!