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. Click on an icon in the timeline to see more information.
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.
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.
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 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 |
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
