Data sought to mea­sure move to value-based pay

Modern Healthcare - - THE WEEK AHEAD - —Joseph Conn

The White House’s ef­fort to quan­tify the na­tion’s progress on con­vert­ing to al­ter­na­tive pay­ment mod­els is about to kick off with a gath­er­ing of heavy hit­ters in the health­care in­dus­try.

Dr. Sam Nussbaum, a for­mer vice pres­i­dent and chief med­i­cal of­fi­cer at An­them, and Dr. Mark McClellan, a for­mer head of the CMS and the Food and Drug Ad­min­is­tra­tion who is now a Duke Univer­sity pro­fes­sor, are among those lead­ing the Health Care Pay­ment Learn­ing and Ac­tion Net­work.

At a two-day sum­mit in Tysons, Va., this week, net­work mem­bers will have the dif­fi­cult task of try­ing to re­cruit pub­lic and pri­vate health plans to pro­vide data. Their goal is to have 200 to 300 pay­ers pro­vide and cat­e­go­rize their pay­ments, ag­gre­gate that data with that of other pay­ers, and iden­tify any ma­jor dif­fer­ences in the adop­tion of al­ter­na­tive pay­ment mod­els, or APMs, among com­mer­cial, Med­i­caid man­aged care and Medi­care Ad­van­tage plans.

“The re­sults of this ef­fort will help the (net­work) as­sess progress to­ward its goal of 30% adop­tion of APMs by 2016 and 50% by 2018 for the U.S. health sys­tem,” ac­cord­ing to a re­cent blog co-writ­ten by Nussbaum and McClellan.

The CMS has pledged to push half of its more than $300 bil­lion in an­nual Medi­care fee-for-ser­vice spend­ing into con­tracts with in­cen­tives to man­age qual­ity and costs by 2018.

Ac­tual data col­lec­tion will be­gin in May and the eight-week quan­ti­ta­tive data sur­vey will run from May 16 to July 8.


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