Alternative Payment Models (APMs)

 

ACOG’s Alternative Payment Models (APMs) 

ACOG has embarked on the development of alternative payment models (APMs) in women’s health.  The objective of this work is to provide a roadmap for our Fellows and payers to implement these models in their practices and markets to create alignment in incentivizes and reporting requirements, while also encouraging the delivery of best practices in women’s health.

ACOG has identified benign hysterectomy and maternity care as the first two APMs that it wants to create.  ACOG will continue to refine these APMs with input from Fellows and other stakeholders.  The eventual goal is to create condition-focused episodes, not just procedural episodes.

Learn more about and provide feedback on the benign hysterectomy episode group.

What Is an APM?  

APM is a catch-all term for payment that is not based solely on fee-for-service.  APMs may include episode groups (also referred to as bundled payments), shared savings, or full capitation (also known as population-based payments).  APMs typically have some level of financial risk built in.  Some models have upside risk, others have downside risk, and some have both (“two-sided risk”).  Upside risk in payment models allows physicians to share in savings with no potential for losses, while downside risk places the physician at financial risk for losses.  APMs also have a quality measurement component to ensure that evidence-based medicine is being delivered.

Episode groups can either be based on a procedure or a condition.  Procedure-focused episode groups have proliferated more so than condition-focused episodes because they have clear starting points and natural end points.  Condition-focused episode groups can be harder to define, particularly for chronic conditions, because of their ongoing nature.  To deal with the lack of precise timing, some condition-focused episode groups focus on acute exacerbations of chronic conditions.  While difficult to develop and implement, condition-focused episodes will help the health system move to value-based care because they do not incentivize one type of procedure or treatment.  

You can learn more about APMs and quality measurement by watching a 25-minute presentation on value-based payments.