Alternative Payment Model (APM) Framework White Paper
Refreshed 2017
Report: Released July 11, 2017
Description
This white paper puts forward an alternative payment model (APM) framework that can be used to track progress on payment reform along a path that supports person-centered care. First published in January 2016 and modified in 2017 to reflect fast-moving developments in the APM landscape, the Framework establishes a common nomenclature for defining, implementing, and sharing successful payment models and has been widely adopted across the health care ecosystem. The 2017 update makes changes to Framework subcategories, clarifies payment reform goals, and identifies ways to increase APM adoption among small, rural, and safety-net providers.
Authors
Publication Info
Publication date: July 11, 2017
47 pages
Suggested Citation: Health Care Payment Learning & Action Network. Alternative Payment Models (APM) Framework.
July 11, 2017.
Table of Contents
Health Care Payment Learning & Action Network (LAN)
Overview and Introduction to the 2017 APM Framework Refresh
Overview of Changes to the APM Framework and Its Supporting Principles
The Case for Reforming the Health Care Payment System
Key Principles of the APM Framework
Fee for Service with No Link to Quality & Value (Category 1)
Fee For Service Linked to Quality & Value (Category 2)
APMs Built on Fee for Service Architecture (Category 3)
Population-Based Payment (Category 4)
Stakeholders and the APM Framework
Appendix A: Category 3 “Incentive-at-Risk” APMs
Appendix B: APM Framework Refresh Advisory Group Members and Staff
CMS Alliance to Modernize Healthcare (CAMH) Staff
Appendix C: Original APM Framework Work Group Members and Staff
Appendix E: Principles for Patient- and Family-Centered Payment
Appendix F: About the CMS Alliance to Modernize Healthcare
Blogs
Accelerating Payment Reform Through Informed and Engaged Family Physicians
by Reid Blackwelder, MD, FAAFP
Changing How we Pay for Primary Care
by Sarah Callahan, MHSA; William Golden, MD, MACP; Susan Edgman-Levitan, PA;
Ensuring the Debate has the Patient in Mind and in the Room
by Patrick Courneya, MD
Increasing Purchasing Power in Washington State
by Dorothy Teeter, MHA
Making Health Care Responsive to Patients
By Nancy Lemond, MA
Paying Providers For Value: The Path Forward
by Sam Nausbaum, MD
Paying Providers For Value: The Path Forward (Update)
by Sam Nausbaum, MD; Patrick Conway, MD, MSc; Mark McClellan, MD, PhD; Mark Smith, MD, MBA
Population-Based Payment Models: Overcoming Barriers, Accelerating Adoption
by Elizabeth Mitchell
Purchasers and Value-Based Payment: What You Can Do Now
by Sally Welborn
Why Regional Data and Local Relationships Will Reform Health Care Payment Nationally
by Elizabeth Mitchell; Dana Gelb Safran, ScD; Glenn Steele, MD, PhD
Archival Materials
Draft APM Framework Refresh paper (May 2017): Alternative Payment Model (APM) Framework
Original APM Framework paper (January 2016): Alternative Payment Model (APM) Framework
Original APM Framework One Pager (January 2016): Alternative Payment Model (APM) Framework
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.
