LAN: White Paper on Clinical Episode Payment Models Released

The Health Care Payment Learning & Action Network (LAN) recently released their final White Paper on Clinical Episode Payment (CEP) models. The paper, developed by the Clinical Episode Payment Work Group, provides guidance for the design and implementation of CEP models, specifically focusing on elective joint replacement, maternity care, and coronary artery disease. The LAN’s white paper, entitled, Accelerating and Aligning Clinical Episode Payment Models, provides a high-level roadmap for providers, health plans, purchasers, and states interested in implementing CEP models with recommendations on how to design these models while leaving enough flexibility to allow for tailored implementation in local markets. The paper addresses how CEP models can position patients and consumers – their clinical needs, values, and preferences – at the center of the health care system.

The paper includes recommendations based on analysis of current episode model initiatives and extensive deliberations of Work Group members. The paper recommends that procedure-based episodes begin at a point pre-procedure, to include the cost of pre-conditioning diagnostics and services. Another recommendation relates to setting the episode population in a way that is broad enough to ensure that the highest-need patients are included and will receive the highest quality, appropriate care. The paper also provides critical thinking about setting the episode price, setting the payment flow, and appropriately adjusting for risk.

In addition to the recommendations themselves, the paper provides detailed information on current initiatives, organized by how they address the ten design elements of the CEP roadmap.

Ultimately, the paper lays a foundation for the LAN to move seamlessly into its next phase of work of assembling a multi-stakeholder action collaborative to implement these recommendations, starting with maternity care.