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
- 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.
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.
CLINICAL EPISODE PAYMENT MODEL
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.
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.
POPULATION-BASED PAYMENT MODEL
These white papers four priority issues that are foundational for the success of population-based payment models.
PRIMARY CARE PAYMENT MODEL
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
Senior Vice President, Compensation & Benefits
Western & Southern Financial Group
Chief Executive Officer
The Health Collaborative
|Andrea Gelzer, MD
Senior Vice President & Corporate Chief Medical Officer
|Steve Farmer, MD|
Senior Advisor and Medical Officer
|David Kendrick, MD
Chief Executive Officer
MyHealth Access Network
Senior Health Policy Analyst
Washington State Health Care Authority
|Renee McLaughlin, MD
Senior Medical Officer, Cigna
|Susan Frampton, Ph.D.|
|Angelo Sinopoli, MD
Chief Clinical Officer, Prisma Health
President, CEO & Founder, Care Coordination Institute