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.
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:
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 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.