Health Care Payment LAN to Increase Focus on Multi-Payer Alignment

Oct. 30, 2023
A key part of multi-payer alignment involves better approaches to integrating specialty care into accountable care payment arrangements and delivery models, says Mark McClellan, M.D., Ph.D., director of the Duke-Margolis Center for Health Policy

On Oct. 30, the Health Care Payment Learning & Action Network (LAN) released data showing consistent growth in alternative payment methods across the U.S. healthcare industry. Speaking at the 2023 LAN Summit, Mark McClellan, M.D., Ph.D., director of the Duke-Margolis Center for Health Policy and co-chair of the LAN Executive Forum, spoke about the LAN’s strategy to continue this momentum in the next year.

The LAN is a group of public and private healthcare leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate adoption of alternative payment models (APMs).

New measurement shows that more than 93 million Americans are in an accountable care arrangement and 72 percent of payers surveyed believe that APM activity will increase in the future.

“We saw progress in payment shifts away from fee for service across all major types of coverage: traditional Medicare and Medicare Advantage, Medicaid and commercial insurance,” said McClellan. “In particular the use of alternative payment models that have a significant shift away from fee for service, the so-called downside risk models including primary care payments with accountability for total cost of care, bundled payments for specialty care and whole-person or direct contracting payments increased by 5 percentage points, the fastest growth rate that we've seen, and a significant acceleration from a 2-percentage point growth rate in 2021. So not only did APM adoption accelerate coming out of the pandemic, but the vast majority of payers are expecting further growth this year and beyond.”

McClellan noted that health systems face continuing economic pressures, workforce issues, the loss of additional payments and flexibilities from the pandemic, rising distrust and many other challenges. “We're facing significant healthcare cost pressures, especially in employer coverage, where alternative payment model adoption has lagged but is now starting to accelerate,” he said. “The LAN is also working hard to expand the CMMI and private sector programs that have evidence-based proof of reducing costs like accountability for total cost of care, along with enhanced payments for advanced primary care, and Medicare's longitudinal Shared Savings Program.”

He added that promising results are coming from ongoing pilots like those that provide advanced payments to smaller primary care and safety net providers. McClellan added that CMS just reported that the early years of the advanced direct contracting programs are also saving money.

McClellan mentioned that the LAN is taking steps to make the upcoming year its most ambitious and action-oriented yet. He said there would be an enhanced focus on alignment across payers. “This multi-payer work will feature expanded efforts to identify and support effective approaches for engaging specialty care and whole-person coordinated care models,” he said.

The LAN created the Accountable Care Action Collaborative (ACAC) a year ago and that group is expanding now with a shared commitment to accelerate accountable care reforms. The ACAC has launched the Accountable Care Curve, which is a resource that brings together the diverse experiences and expertise of all of these groups and their members around what works in accountable care reform, McClellan explained. “We know that that's different across urban and rural areas, small and large organizations.”

He described the Accountable Care Curve as a tool that facilitates adoption of alternative payment models, as well as critical supporting reforms by helping organizations and people engaging in these efforts find where they are, and see similar experiences that organizations have gone through, including around improving quality measurement and quality improvement activities, supporting data infrastructure, interoperability to advance health equity, multi-stakeholder alignment on data and measurement standards and other supporting components of accountable care. reforms.

McClellan also mentioned the work of the State Transformation Collaboratives in four diverse states to promote action and shareable insights, tools and guidance, not only in those states, but on effective multi-stakeholder collaboration that can be adopted more widely to advance accountable care across the country. The State Transformation Collaboratives released a multi-payer blueprint, which builds on work by Duke Margolis and others to show how states can succeed in aligning payment transformation efforts across payer markets in areas like performance measurement and reporting, health equity, payment model components and data sharing.

The LAN is now reinforcing these efforts through a new national health plan workgroup that will help identify alignment opportunities across these national and regional efforts, again, with the goal of reducing administrative burden and making it easier to improve care delivery, McClellan said.

“While CMS has this broad goal and a broad range of stakeholders coming together for engagement in many of their own initiatives, these public/private collaborations supported by the LAN provide additional opportunities to inform CMS initiatives, to increase alignment and reduce burden for healthcare reforms,” he said.

A key part of multi-payer alignment involves better approaches to integrating specialty care into accountable care payment arrangements and delivery models, McClellan said. Many specialists aren't yet well integrated into accountable care, which creates barriers to the goal of whole-person longitudinal coordinated care, he added. “The LAN multi-payer alignment effort in the coming year is going to focus on identifying tools and practices to encourage and advance specialist participation — for example, feasible performance measures that are being used and could be adopted more widely to identify and support high-value specialty care.”