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ANCOR's Alternate Payment Model Work Group

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ANCOR's Alternate Payment Model Work Group

by: 
Ken Lovan (ResCare) and Mark Davis (OPRA), Workgroup Co-Chairs

The number of states, policymakers and payers contemplating new models of payments that focus on outcomes, value and assumption of risk has grown exponentially. It is vital that community providers are actively involved in the process of developing, advancing and implementing new approaches that better meet the needs of funders and beneficiaries while promoting greater provider autonomy and flexibility. With this in mind, ANCOR convened the Alternate Payment Model Work Group to identify and assess current and potential financing models that move beyond the current fee for service system.

This effort began in 2016 and was accelerated in December 2017 with an initial meeting of Work Group members, who represented a cross section of ANCOR membership. During the meeting, Work Group members heard from the leadership of the National Association of Medicaid Directors (NAMD), the National Association of State Directors of Developmental Disabilities Services (NASDDDS), and the Centers for Medicare and Medicaid Services (CMS), who provided helpful insights and input into this initiative.

ANCOR also engaged the consulting services of Vikki Wachino, former Director of the Center for Medicaid and CHIP Services within CMS, who has provided valuable expertise and a unique perspective. Vikki recently partnered with HCBS expert Molly Watts to develop the final workgroup products.

Alternative Payment Models Work Plan for 2018

The Work Group developed a Work Plan for 2018 by conducting monthly calls to discuss alternate models, obtain member input and share relevant information among members. Key items in the resulting Work Plan for 2018 included:

  • Establishing key principles to guide the assessment of alternate payment models
  • Defining I/DD providers’ “value proposition”
  • Translating key concepts of Medicaid innovation and value-based purchasing to I/DD services
  • Identifying, exploring and assessing current and potential alternate payment models
  • Identifying potential state and payer partners to further explore new payment models
  • Identifying potential federal authorities needed to support alternate payment models
  • Engaging other stakeholders in consultation
  • Completing a final set of Work Group recommendations

Highlights to Date

Please refer to the ANCOR Alternative Payment Model Work Group Mid-Year Status Report for a more detailed list of activities, progress updates and list of Work Group members. The following are a few highlights from the Work Group’s effort to date:

  • The most significant activity has been to review and discuss existing and potential alternate payment models. Although models from several states were discussed, two models garnered much of the focus:
    • Keystone Human Services Managed Care Model, in which Keystone is the provider-MCO with a direct contract with the State of Pennsylvania for a full-risk managed care model with a capitated rate serving 150 adults with Autism.
    • Provider-Led Arkansas Shared Savings Entity (PASSE), in which provider-owned organizations are responsible for integrating HCBS and all health and behavioral services under a full-risk based and global capitated model.
  • The Work Group also met with the leaders of key national groups including CMS, NAMD, NASDDS, the National Association of States United for Aging and Disabilities and the Council on Quality & Leadership. Work Group members had extensive discussions with these potential partners to gain valuable insight to guide ANCOR. The Work Group also shared its recommendations with these groups to get their feedback. These meetings proved fruitful and should continue in the future; they should also expand to include beneficiary advocacy and other external groups.
  • After months of active discussion regarding current and future payment approaches for people with I/DD, review of relevant research and promising practices, and discussions with some key stakeholders and CMS, the Work Group is completing recommendations to include in its Final Document, which should be released in January 2019.

Final Thoughts

The Work Group's efforts would not be possible without the full support, resources and efforts of ANCOR's Government Relations staff and consultants, and we extend special thanks to the members of the Work Group whose contributions have been significant.

Even with a relatively small and focused set of members, the Work Group experienced some degree of difficulty in achieving consensus on the types of models and strategies to pursue. Given the diversity of how services are delivered among the states, this isn't surprising, nor do we interpret it as a bad thing. Rather, it underscores that there is no one-size-fits-all approach, and thus we must be committed to incorporating a diverse range of ideas, input and experience in this initiative.

The other reality of this effort is the overwhelming nature of the subject matter and the limited time/resources of the Work Group. Much more time could be spent diving deeper into some of the state models or further defining value-based outcomes for I/DD.

Keeping in mind the main two goals of this initiative (to better educate members and encourage them to participate in pursuing alternate payment models, and to convince policymakers and payers of the value of further engaging providers in this process), the Work Group will recommend that ANCOR continue similar APM efforts in 2019, involving key external partners and focusing on developing specific models and strategies.