HHS is gearing up to design and implement a revised Medicare payment system.  The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has designated a merit based incentive payment system (MIPS) as a goal.  CMS is tasked to design a value based payment system based upon quality, resource use, clinical practice improvement, and meaningful use certified EHR technology.

As part of the implementation, HHS and the CMS Innovation Center have established the Health Care Payment Learning and Action Network.

HCP-LAN published a whitepaper “Alternate Payment Model (APM) Framework” on January 12, 2016.

Ironically, the work group believes the person centered care rests upon 3 pillars (quality, cost effectiveness, and patient engagement), instead of a Triple Aim (patient experience, population health, and cost).

The whitepaper states that the new alternative payment model (APM) framework rests on 7 principals:

  1. Changing providers financial incentives is not sufficient to achieve person centered care, so it would be essential to empower patients to be partners in healthcare transformation (this has previously been called patient involvement or consumerism).
  2. The goal for payment reform is to shift US health care spending significantly towards population based and more person focused payments (and fee for service).
  3. Value based incentives should ideally reach the providers that deliver care.  (This was previously called moving the needle or bending the cost curve.)
  4. Payment models that do not take quality into account are not considered APMs and the APM framework, and do not count as progress toward payment reform.  (This is self explanatory.)
  5. Value based incentives should be intense enough to motivate providers to invest in and adopt new approaches to healthcare delivery.  (This is a correlated item 5 is that the incentive must be meaningful enough to actually change care).
  6. APMs will be classified according to the dominate form of payment when more than one type of payment is used.
  7. Centers of Excellence, accountable care organizations, and patient centered medical homes are examples rather than categories in the APM framework.

Sadly, if you read the new goals and the whitepaper, I am sure most of you will agree that this is nothing new.  These goals, these theories, these pillars and these triple aims are, I think, commonly accepted by everybody.  Implementation in a healthcare system that has incentivized volume based payment for both hospitals and individual providers for the last 20 years (actually 50+ years for Medicare physician reimbursement) and what is essentially the largest for profit industry in the country, will be a challenge.