AIM:
More Equitable Health Outcomes
Intentionally designed APMs can help mitigate the negative impact that explicit and implicit biases and structural racism have on historically marginalized communities. By incentivizing and supporting care delivery changes that make care more equitable, APMs can drive better patient outcomes, reduce disparities, and advance health equity.
INTERMEDIATE OUTCOMES:
Change starts by incorporating APM design elements (secondary drivers) that are structured to incentivize and support equitable care delivery. If successfully implemented, these changes will result in people accessing culturally appropriate and integrated care; providers delivering more equitable and accessible care; and payers, providers, and purchasers identifying opportunities for disparities reduction, setting specific and actionable health equity goals, and monitoring performance.
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Payers and purchasers can voluntarily adopt promising design elements into APMs in an aligned manner to maximize provider uptake and the positive impact of APMs on health equity. |
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Providers participating in these APMs can make changes in care delivery that will enable them to advance health equity in a way that is flexible and aligned with fulfilling their mission |
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Individuals, families, their communities, and other relevant stakeholders can work with payers, purchasers, and providers to ensure changes in health care delivery and payment through APMs reflect their needs and preferences for change. |
PRIMARY DRIVERS
APMs leverage three inter-related features that are especially important for advancing health equity: Care Delivery Redesign, Payment Incentives and Structures, and Performance Measurement. These features:
- Hold provider organizations accountable for delivering better care and achieving better health outcomes for all individuals;
- Give providers greater flexibility to deliver whole-person care, consistent with each individual’s community, culture, and identity; and
- Increase accessibility and use of effective, appropriate, and affordable care and services.
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Care Delivery Redesign lays out expectations within APM contracts for how care is delivered |
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Payment Incentives and Structures |
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Performance Measurement |
MULTI-PAYER ALIGNMENT
Alignment across payers for select design elements promotes APM adoption among providers, ultimately bolstering positive impacts on communities experiencing health inequities.
Payers | 
Providers | 
Purchasers | Policy Makers
Community Organizations
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
