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 areasRIG members were independently consulted for their perspectives on what constitutes a successful APM, and this information will be incorporated into the APM Roadmap report. Click on an icon in the timeline to see more information.

    The Work Group selected the following criteria to identify
    successful APMs.

    SUCCESS CRITERIA

    1. Cost: APMs should reduce total cost of care. 
    2. 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

    1. Patient Experience: APMs should improve patients’ experience of care, particularly with respect to the ease of accessing care that is covered by insurance plans. 
    2. Provider Experience: APMs should reduce administrative burden for providers and improve provider satisfaction. 
    3. Health Equity: APMs should improve health equity by reducing health disparities where they exist.

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

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

    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.

    Maternity Care
     Cardiac Care
     Elective Joint Replacement

    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.

    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
    CMMI
    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.
    President
    Planetree International
    Angelo Sinopoli, MD
    Chief Clinical Officer, Prisma Health
    President, CEO & Founder, Care Coordination Institute

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