价值导向护理的新市场趋势

Approved for Public Release; Distribution Unlimited. Case Number 17-2546ContentsExecutive Summary....................................................................................................................................... 1Health Care Payment Learning & Action Network ................................................................................... 1Overview and Introduction to the 2017 APM Framework Refresh .............................................................. 3Overview of Changes to the APM Framework and Its Supporting Principles........................................... 5The Case for Reforming the Health Care Payment System .......................................................................... 7Purpose of the White Paper.................................................................................................................... 10Approach................................................................................................................................................. 10Key Principles for the APM Framework ...................................................................................................... 11The APM Framework .................................................................................................................................. 22Fee for Service with No Link to Quality & Value (Category 1):........................................................... 24Fee for Service Linked to Quality & Value (Category 2): .................................................................... 24APMs Built on Fee-for-Service Architecture (Category 3):................................................................. 25Population-Based Payment (Category 4): .......................................................................................... 27Conclusion................................................................................................................................................... 30Stakeholders and the APM Framework .................................................................................................. 30Appendix A: Category 3 “Incentive-at-Risk” APMs ..................................................................................... 31Appendix B: APM Framework Refresh Advisory Group Members and Staff.............................................. 35Advisory Group Chair .............................................................................................................................. 35Advisory Group Members....................................................................................................................... 35CMS Alliance to Modernize Healthcare (CAMH) Staff ............................................................................ 35Appendix C: Original APM Framework Work Group Members and Staff................................................... 37Work Group Chair ................................................................................................................................... 37Work Group Members ............................................................................................................................ 37Appendix D: Other LAN Content ................................................................................................................. 39Appendix E: Principles for Patient- and Family-Centered Payment ........................................................... 43Appendix F: About the CMS Alliance to Modernize Healthcare ................................................................. 45 i© 2017 The MITRE Corporation. ALL RIGHTS RESERVED Approved for Public Release; Distribution Unlimited. Case Number 17-2546Executive SummaryThe Health Care Payment Learning & Action Network(LAN) was created to drive alignment in paymentapproaches across the public and private sectors ofthe U.S. health care system. The CMS Alliance toModernize Healthcare (CAMH), the federally fundedresearch and development center (FFRDC) operatedby the MITRE Corporation, was asked by the Centersfor Medicare & Medicaid Services (CMS) to convenethis large national initiative.To advance the goal of aligning payment approaches,the Alternative Payment Model Framework andProgress Tracking Work Group (the “Work Group”)was charged with creating an alternative paymentmodel (APM) Framework (the “APM Framework”)that could be used to track progress toward paymentreform. Composed of diverse health carestakeholders, the Work Group deliberated andreached consensus on many critical issues related tothe classification of APMs, resulting in a rationale anda pathway for payment reform capable of supportingthe delivery of person-centered care. The WorkGroup published the APM Framework White Paper inJanuary 2016. Subsequently, a multi-stakeholderAdvisory Group was convened to update the APMFramework and its principles based on developmentsthat occurred since the original publication. ThisWhit