In laying the foundation for this work, the HCP-LAN team conducted background research to gain insight into successful APM implementation. This exploratory research included a targeted literature review, as well as discussions with 25 stakeholders who have a deep understanding of, and experience in, APM implementation. A primary goal was to obtain information about potential correlates of successful APMs, including both characteristics of APMs (such as size or level of experience) as well as actions taken by either payers or providers in the design and/or implementation of an APM to  improve outcomes. In addition, the team explored common challenges encountered by APM implementers and potential solutions for overcoming barriers. Click on an icon in the timeline to see more information.

    Based on this research, the Roadmap is expected to explore best practices in the following areas:

    • The need for strong, committed health plan and provider leaders, who build trust with each other and with front-line practitioners.
    • Determining level of flexibility in the risk framework and  payment approaches to enhance population health infrastructure.
    • The adoption of new technologies and data sharing approaches, as well as how strategies for addressing technical limitations, lack of interoperability, and workforce constraints.
    • The role of care coordination, including strategies to impact high-need or high-cost  patients.
    • The importance of engaging physicians as partners in value-based transformation, including involving them in APM design and implementation.
    • Best practices for patient centeredness, particularly the involvement of patients and families in APM design, implementation, and evaluation.
    • Key strategies and considerations for multi-payer collaborations, including observations about consensus-building, anti-trust concerns, technology gaps, and local market and policy environments.
    • How purchasers are working directly with providers to build high-value networks through Centers of Excellence (COE), using benefit design to incentivize their utilization.

    Read the APM Roadmap Initiative Overview.
    Feel free to share and as always we welcome your feedback and questions!

    Exploring APM Success Factors: Insights from a Focused Review.
    Download a copy to read about the progress of the APM Roadmap Initiative.

    These documents describe an alternative payment model (APM) framework that can be used to track progress on payment reform along a path that supports person-centered care.

    APM Framework
    Journal of American Medical Association Article

    These white papers provide high-level recommendations for designing clinical episode payment models. A clinical episode payment is a bundled payment for a set of services that occur over time and across settings.

    Maternity Care
     Cardiac Care
     Elective Joint Replacement

    Online resource banks which provide a one-stop-shop for all the information and resources needed to facilitate implementation for certain specialty models.

     Maternity Care Resource Bank
    Primary Care Payer Resource Bank

    These white papers four priority issues that are foundational for the success of population-based payment models.

     Patient Attribution
     Financial Benchmarking
    Data Sharing
    Performance Measurement

    This paper offers principles and recommendations for implementing PCPMs that can help overcome the barriers to effective primary care tied to traditional fee-for-service payments based on the volume of services provided rather than the quality and value of care.

    Primary Care Payment Model

    Thomas Buckingham, BSN, MBA Chair
    Executive Vice President
    Select Medical
    Steve Hussey
    Senior Vice President, Compensation & Benefits
    Western & Southern Financial Group
    Craig Brammer
    Chief Executive Officer
    The Health Collaborative
    Andrea Gelzer, MD
    Senior Vice President & Corporate Chief Medical Officer
    Amerihealth Caritas
    Steve Farmer, MD
    Senior Advisor and Medical Officer
    David Kendrick, MD
    Chief Executive Officer
    MyHealth Access Network
    JD Fischer
    Senior Health Policy Analyst
    Washington State Health Care Authority
    Renee McLaughlin, MD
    National Medical Director, Value-based Relationships, Cigna
    Susan Frampton, Ph.D.
    Planetree International
    Angelo Sinopoli, MD
    Chief Clinical Officer, Prisma Health
    President, CEO & Founder, Care Coordination Institute

    Copyright © 1997-2020, The MITRE Corporation. All rights reserved. MITRE is a registered trademark of The MITRE Corporation. Material on this site may be copied and distributed with permission only.

    Log in with your credentials


    Forgot your details?

    Create Account