The Health Care Payment Learning and Action Network (LAN) is a group of public and private health care leaders who work to lower the costs of health care, improve patient experiences and outcomes, and reduce barriers to value-based payment participation for providers. The LAN classifies payment models into the four categories described in the framework below. Included are details about which categories meet Oregon value-based payment (VBP) requirements for Patient-centered Primary Care Homes (PCPCHs) and coordinated care organization (CCO) targets and care delivery areas (CDAs).
LAN payment categories
Category 1: Fee for Service – no link to quality and value
Category 2: Fee for Service – link to quality and value
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2A: Foundational Payments for Infrastructure and Operations (for example, care coordination fees and payments for HIT investments)
- Qualifies for annual PCPCH VBP requirement.
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2B: Pay for Reporting (for example, bonuses for reporting data or penalties for not reporting data)
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2C: Pay-for-Performance (for example, bonuses for quality performance)
- Qualifies for annual CCO VBP targets and CDAs.
Category 3: APMs Built on Fee-for-service Architecture
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3A: APMs with Shared Savings (for example, shared savings with upside risk only)
- Qualifies for annual CCO VBP targets and CDAs.
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3B: APMs with Shared Savings and Downside Risk (for example, episode-based payments for procedures and comprehensive payments with upside and downside risk)
- Qualifies for annual CCO VBP targets and CDAs.
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3N: Risk-based Payments NOT Linked to Quality
Category 4: Population-based Payment
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4A: Condition-Specific Population-Based Payment (for example, per member per month payments for specialty services, such as oncology or mental health)
- Qualifies for annual CCO VBP targets and CDAs.
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4B: Comprehensive Population-Based Payment (for example, global budgets or full/percent of premium payments)
- Qualifies for annual CCO VBP targets and CDAs.
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4C: Integrated Finance and Delivery System (for example, global budgets or full/percent of premium payments in integrated systems)
- Qualifies for annual CCO VBP targets and CDAs.
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4N: Capitated Payments NOT Linked to Quality