Alternative Payment Models and Value-Based Care: There’s a Framework for That

 In Analytics & Data Management, Healthcare Transformation

Aparna Higgins’ career has been focused on value-based payment. More than ten years ago, while she was at Booz-Allen, she co-led the design of the Medicare Hospital Value-Based Purchasing report to Congress. It was one of the first programs recommended to the CMS that defined how hospitals could be assessed and rewarded for care quality. The report’s recommendations were implemented when the CMS was authorized under the Affordable Care Act to implement the program.

More recently, as an executive at AHIP (America’s Health Insurance Plans), Aparna led organizational efforts on payment and delivery system reform, included examining and identifying industry-wide best practices in the design and implementation of Alternative Payment Models (APMs), and the core quality measures collaborative. She’s spent most of her career thinking about incentives, incentive design, and how to assess and reward performance.

These days Aparna is the founder and CEO of Ananya Health Innovations. She’s also a guiding committee member of the Health Care Payment Learning & Action Network, also known as “the LAN,” which was established to accelerate the healthcare system’s transition to alternative payment models. The LAN’s major contribution to the industry is the APM Framework, which provides healthcare stakeholders with a roadmap to understand, design, and assess the adoption of alternative payment models.

We asked Aparna to join us on the podcast to talk about how the APM Framework can help payers and providers achieve their value-based payment goals. On today’s show, we’ll take you through:

  • The LAN’s mission and how it created APMs (02:16)
  • The roadmap, benchmark, and other tools the LAN created to help payers achieve their VBC goals (06:06)
  • A dive into the APM roadmap’s three pillars: APM design, payer/provider collaboration, and patient-centered care (10:20)
  • Why having access to better data is better for providers (15:51)
  • How payers can support providers, especially smaller providers, in analyzing data and identifying areas to focus on (19:12)
  • How payers and providers are changing patient engagement in the real world (21:29)
  • Evolving an APM from retrospective to prospective (28:19)
  • The importance of outcome-focused measurements (33:09)
  • Key tips for payers on advancing their APM programs (35:15)
  • What providers need to be successful in APM models (37:00)
  • How leadership and organizational culture for both payers and providers is key to success (39:00)
  • Aparna’s closing thoughts (40:54)

Episode Resources

  1. Contact Patrick McGuigan
  2. Aparna Higgins bio
  3. The Healthcare Payment Learning & Action Network
  4. The HCP-LAN APM framework
  5. Research: Value-Based Care State-by-State
  6. Seminar: How Anthem is Scaling Value-Based Payment
  7. Value-Based Payment Resource Hub

Show Resources

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