skip to Main Content

Alternative Payment Model Coming to A Healthcare Provider Near You

Written by: Mediware on Tuesday, April 21, 2015 Posted in: Acute Care Rehab

CMS, in their quest to guide payment away from fee-for-service toward ‘paying providers based on the quality, rather than the quantity of care they give patients’, is entering on a whole new horizon. It’s time to take a peek and define when, where and how you feel APM fits into your book of business.

Why do this? Because APM is Medicare’s future preferred payment methodology and they have created a Healthcare Payment and Learning Action Network to enable best practice creation and feedback stories that will help bring an entire nation to embrace pay-for-performance on an all new scale.

On January 26, 2015, Health and Human Services Secretary, Sylvia M. Burwell, announced measurable goals and a timeline to move the Medicare program, and health systems at-large, toward paying providers based on quality, rather than the quantity of care given to patients.  APMs, as part of their goal statement, will encompass 30 percent of fee-for-service providers by 2016 and no less than 50 percent in an aggressive push to move from standard fee-for-service to quality, not quantity, as the payment model of choice.  Both dates include a serious percentage of  payment linked to quality data.


You do not have to sit back with a wait-and-see attitude. In fact, CMS is encouraging participation in a Healthcare Payment and Learning Action Network. This network had its first meeting at the end of March, but it’s not too late to get on board!

CMS states, “The Learning and Action Network will accelerate the transition to more advanced payment models by fostering collaboration between HHS, private payers, large employers, providers, consumers, and state and federal partners. Working together, Learning and Action Network partners will:

  • Serve as a convening body to facilitate joint implementation and expansion of new models of payment and care delivery
  • Identify areas of agreement around movement toward alternative payment models and define how best to report on these new payment models
  • Collaborate to generate evidence, share approaches, and remove barriers
  • Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, and risk adjustment
  • Create implementation guides for payers and purchasers”

As you have seen, the list of WHO can participate certainly includes whether you are a payor, provider or consumer! That’s just about anyone!

This Network, which can include YOU, will be supported by an independent contractor that will coordinate and facilitate various meeting types and agendas. Most of the work will be done remotely so there is no excuse for participation that might be above cost to participate. How can such a committee be unbiased you might ask?

CMS has hired a network management company that will operate independently of Health and Human Services and the Centers for Medicare and Medicaid, as well as all other government agencies. The object is to get unbiased participation, feedback and committed efforts from all its participants. A guiding committee will be drawn from participants in the Network and workgroups will be created by the contractor to address topics of interest listed by the guiding committee.

Since we know the goal and the quick efforts that HHS and CMS is making to meet an Alternative Payment Model, now is the time to become engaged. Anyone can register and this includes YOU!

It’s time to be a part of healthcare solutions to enhance quality care at the right price. Make your voice heard, because a ‘wait-and-see’ attitude may not include ideas you feel should be considered.

Back to top