Alternative Payment Models: The Courage to Lead
If you were an HFMA member in 2006, you may remember my theme when I served as national Chair that year: Courage in Leadership.
That theme may be more relevant than ever today. It takes courage to lead at a time when uncertainties about health policy have never been greater. In the aftermath of a divisive election, the new administration has yet to send clear and unambiguous signals about its intentions with respect to many aspects of health policy. Preliminary indications are that HHS Secretary Tom Price will favor giving states more latitude to make decisions about alternative payment models (APMs) rather than mandating participation at the federal level—not necessarily a negative thing, but a major change, nonetheless.
As we try to make sense of rapidly changing events in our nation’s capital, it wouldn’t be surprising if healthcare leaders were inclined to put their strategic plans on hold, especially those related to APMs. It takes courage to move forward amid so much uncertainty. But I’m happy to say that healthcare finance leaders are marshaling their courage and going full steam ahead—at least, those who attended HFMA’s National Payment Innovation Summit in Dallas in February are doing so. We asked attendees about their plans for pursuing outcomes-based payment in light of political uncertainties. Just two reported that they were deferring their plans pending changes the new administration might make.
HFMA is also committed to moving forward with the value transformation, and we have conveyed that commitment to decision-makers at the highest levels of government. Along with a coalition of dozens of leading providers, health plans, and other associations, HFMA co-signed a letter to the Trump administration and congressional leaders urging them to continue driving value-based, patient-centered payment models that incent healthcare innovation. “Now is not the time for policymakers to signal a shift away from value-based care, either through action or inaction,” the coalition writes.
There is no question that we are making progress, as an industry. In October 2016, a study by HHS’ Health Care Payment Learning & Action Network on the use of APMs by public and private health plans found that nearly 25 percent of payments are in APMs that support better care coordination and patient care. Another study conducted by the consulting firm KPMG found that 44 percent of respondents at health plan and provider organizations have a population health management platform in place, while 24 percent plan to implement such a program in the next three years.
Do these levels of APM participation constitute critical mass? It’s hard to say. We may know what critical mass is only when it’s in the rear-view mirror. What I know for sure is that we’re at a point where the actions—or inactions—of every healthcare leader make a difference to the industry as a whole. But it will require a willingness to take risks, to reach out to new partners, to accept and embrace change—and that takes courage. I am confident that today’s healthcare finance professionals have the courage to lead.
Follow Joe Fifer on Twitter: @HFMAFifer
From the President’s Desk
Joe Fifer expands on his ideas in his March column.