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CMS establishes Health Care Payment Learning and Action Network

April 13, 2015

Since the passage of the Affordable Care Act, we have been discussing the move from volume payment to value payment in healthcare. Now, you have an opportunity to have an impact on CMS’ alternative payment models.

On March 25, 2015, CMS launched its Health Care Payment Learning and Action Network (HCPLAN) with an express goal to improve care, curb healthcare costs, and promote a healthier population. More to the point, HCPLAN is an effort by CMS to implement meaningful payment changes to our healthcare system through an engaged network of public and private participants, including payers, providers, consumers, and states.

The stage was set for HCPLAN when HHS publicly announced in January 2015 its bold agenda for payment transformation, targeting specific timelines and percentages: (i) by the end of 2016, Medicare payments would shift 30% of fee-for-service payments to “alternative payment models” through such vehicles as accountable care organizations or bundled payment initiatives and (ii) by the end of 2018, 50% of current Medicare payments would be related to these alternative models. CMS recognizes that meaningful changes in operational efficiency, care coordination, and care delivery can only happen if value-based payments become tangible and transparent. HCPLAN is designed both to gather meaningful insights from the various stakeholders and to assist in the process of implementing payment reform.

HCPLAN is intended, in part, to “identify areas of agreement” for new payment models and reporting methods. More generally, it would seem, HCPLAN has the challenge of working to define value for healthcare delivery, to determine how to measure value and then how to pay for that value. This is no small task, and the end game, if successful, will be well-defined, alternative approaches to payment, likely including episodic payment, risk assumption, and other variations on capitation.

HCPLAN will be organized and facilitated by a contracted party that will serve as a convener and facilitator. CMS has set lofty goals for the work of HCPLAN and appears willing to address the complexity of healthcare payment reform. For example, CMS includes in its initial topical survey for HCPLAN registrants references to potential problems with alternative payments, attribution, and overlapping payment models.

The organization of HCPLAN provides an opportunity for meaningful and deliberative dialogue among provider organizations, payers, and other stakeholders to shape the definitions and commitment of determining and rewarding value in our healthcare system. Organizations and individuals are invited to participate in HCPLAN through its website enrollment at https://hcp-lan.org/.