Current Alternative Payment Models (APMs)

Quality & Practice

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The Centers for Medicare and Medicaid Services (CMS) has 7 categories of payment and service delivery models. Click below for a full listing of each category or view all. (You can also search by state, region, or stage of development). 

Please note: APMs are not limited to CMS. There are many available through commercial insurers. 

  • Accountable Care
    Accountable Care Organizations and similar care models are designed to incentivize health care providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.
  • Episode-based Payment Initiatives
    Under these models, health care providers are held accountable for the cost and quality of care beneficiaries receive during an episode of care, which usually begins with a triggering health care event (such as a hospitalization or chemotherapy administration) and extends for a limited period of time thereafter.
  • Primary Care Transformation
    Primary care providers are a key point of contact for patients’ health care needs. Strengthening and increasing access to primary care is critical to promoting health and reducing overall health care costs. Advanced primary care practices – also called “medical homes” – utilize a team-based approach, while emphasizing prevention, health information technology, care coordination, and shared decision making among patients and their providers.
  • Initiatives Focused on the Medicaid and CHIP Population
    Medicaid and the Children’s Health Insurance Program (CHIP) are administered by the states but are jointly funded by the federal government and states. Initiatives in this category are administered by the participating states.
  • Initiatives Focused on the Medicare-Medicaid Enrollees
    The Medicare and Medicaid programs were designed with distinct purposes. Individuals enrolled in both Medicare and Medicaid (the “dual eligibles”) account for a disproportionate share of the programs’ expenditures. A fully integrated, person-centered system of care that ensures that all their needs are met could better serve this population in a high quality, cost effective manner.
  • Initiatives to Speed the Adoption of Best Practices
    Recent studies indicate that it takes nearly 17 years on average before best practices - backed by research - are incorporated into widespread clinical practice—and even then the application of the knowledge is very uneven. The Innovation Center is partnering with a broad range of health care providers, federal agencies professional societies and other experts and stakeholders to test new models for disseminating evidence-based best practices and significantly increasing the speed of adoption.
Please note: Due to the risk involved in APMs, it is important to understand your options thoroughly.