The APM Roadmap Work Group determined that APMs should meet certain cost and quality criteria to be considered for their insights on best practices. Although cost and quality are the primary selection criteria, the Work Group also established patient experience, provider experience, and health equity as domains to consider within high-performing APMs, recognizing that they may still be in the nascent stages of addressing these critical areas. RIG members were independently consulted for their perspectives on what constitutes a successful APM, and this information will be incorporated into the APM Roadmap report.
The Work Group selected the following criteria to identify
successful APMs.
SUCCESS CRITERIA
- Cost: APMs should reduce total cost of care.
- Quality: APMs should improve or maintain high quality of care for patients, preferably determined by outcome measures that are meaningful to patients and consumers.
ADDITIONAL DOMAINS OF SUCCESS
- Patient Experience: APMs should improve patients’ experience of care, particularly with respect to the ease of accessing care that is covered by insurance plans.
- Provider Experience: APMs should reduce administrative burden for providers and improve provider satisfaction.
- Health Equity: APMs should improve health equity by reducing health disparities where they exist.
APM FRAMEWORK
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
CLINICAL EPISODE PAYMENT MODEL
WHITE PAPERS
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.
POPULATION-BASED
AND SPECIALTY MODELS
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
POPULATION-BASED PAYMENT MODEL
WHITE PAPERS
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
PRIMARY CARE PAYMENT MODEL
WHITE PAPERS
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.
 | 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 CMMI |  | David Kendrick, MD Chief Executive Officer MyHealth Access Network |
 | JD Fischer Senior Health Policy Analyst Washington State Health Care Authority | | Renee McLaughlin, MD Senior Medical Officer, Cigna |
 | Susan Frampton, Ph.D. President Planetree International |  | Angelo Sinopoli, MD Chief Clinical Officer, Prisma Health President, CEO & Founder, Care Coordination Institute |
