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.

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.

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
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

Copyright © 1997-2018, 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

or    

Forgot your details?

Create Account