About Us

What is the Health Care Payment Learning & Action Network?

Launched in 2015 by the U.S. Department of Health and Human Services (HHS), the Health Care Payment Learning & Action Network (LAN) is a public-private partnership whose mission is to accelerate the health care system’s transition to alternative payment models (APMs) by aligning the innovation, power, and reach of the private and public sectors. The LAN’s purpose is to facilitate the shift from the fee-for-service (FFS) payment model to a model that pays providers for quality care, improved health, and lower costs. The LAN is led by a Guiding Committee that provides executive leadership and strategic direction to accelerate achieving the goals described below. The LAN offers stakeholders a broad portfolio of resources to facilitate that transition, including the APM Framework, primary care and maternity care APM resource banks, and white papers on a wide range of topics related to designing episode-based and population-based APMs.

The goals of the LAN include:

  • Linking 50% of all health care payment in the U.S. to quality and value through APMs by 2018
  • Increasing the alignment of APM components, such as quality measures, risk adjustment, and data sharing, within and across the public and private sectors
  • Diffusing cutting-edge knowledge and promising practices on operationalizing APMs to accelerate the design, testing, and implementation of APMs

 

 

The APM Framework is the LAN’s landmark contribution to health care payment transformation via APMs. It captures a continuum of clinical and financial risks for provider organizations across four payment categories.

Stakeholders can use the Framework to:

  • Assist patient advocacy groups in understanding the context behind plan and benefit design, and in participating in decisions about how to design payment plans and delivery systems.
  • Help providers understand the payment reforms underway, assess their current status, and plan future reforms.
  • Drive payer models and track spending and the distribution of members/beneficiaries and providers.
  • Facilitate purchasers in educating their employees about the health insurance landscape and sharing information for population-based plans.

At least nine states are using the Framework to track spending in Medicaid managed care contracts, and many require payers to meet spending targets in Categories 2 through 4.

   Launched the Roadmap for Driving High
   Performance in APMs

  • Promote the adoption of high-performing, value-based payment models by identifying APMs that meet meaningful goals related to cost and quality
  • Identify the most promising practices
  • Developed a guide (the APM Roadmap) for payers to create and implement high-performing APMs

   Conducted Annual Measurement of the
   Health Care Payment Landscape

  • Produced data that tracked the steady increase in the adoption of APMs across public and private payers
  • For 2016, health care payments by Framework category were:
    • Category 1 (FFS), 43%
    • Category 2 (FFS plus quality and value), 28%
    • Categories 3 (APMs) and 4 (population-based payment), 29%

   Five National Summits and Multiple
   Web-based Learnings

  • Convened meetings of thousands of health professionals to share lessons learned and promising practices in innovations in payment reform, implementation tactics, and public/private collaboration efforts
  • Health care professionals include payers, purchasers, consumer and patient advocates, state agency and Medicaid representatives, federal agency representatives, and national policymakers

Created a Large Portfolio of Resources

  • White papers and informational graphics
  • Resources on population-based payment, clinical episode payment, data sharing, and primary care payment reform that stakeholders can use to facilitate APM adoption

Facilitated Two National Forums for Stakeholders to Develop Real-world Solutions to APM Design and Other Implementation Challenges

  • The Primary Care Payer Action Collaborative (PAC) convened payers involved in multi-payer primary care APMs and created the Primary Care Payer Action Collaborative Resource Bank, full of useful sources to help payers operationalize alternatives to fee-for-service payment
  • The Multi-Stakeholder Maternity Care Action Collaborative (MAC) convened stakeholders across the maternity care system to learn about proven strategies for designing and implementing episode payment models for maternity care. The MAC led to the development of the Maternity Episode Payment Online Resource Bank, a one-stop-shop for maternity APMs, including information on making the business case for maternity APMs and lessons learned.