Smart Guide for APM Success
Value-Based Care is at a tipping point. But it’s not just about whether providers adopt alternative payment models (APMs) or ACOs. The real tipping point is whether traditional health systems can get on board fast enough to survive the corporate health care business that is poaching providers and patients. Corporate health care is not only unfazed by downside risk of APMs, but also has built their business models on population-based payments.
Alternative Payment Models (APMs) and ACOs are the CMS response to transforming the health system and its volume-driven costs. However, traditional providers have stalled in ACO development and participation. That’s why two recent CMS actions deserve a lot of attention: the ACO REACH program that involves population-based payments and has recently gone through provisional approval of just over 100 applicants, and the proposed rule to lengthen the glide path to downside risk for MSSPs and lower the barrier to entry for new ACOs.
The fact is that most providers are really far behind in their ability to turn the revenue ship from FFS to APMs. Doing it is a monumental task involving renegotiation of many payer contracts and revamping financial systems, provider entities, physician compensation, and consumer-patient relationships. Intensifying this huge challenge, data will almost certainly be insufficient to determine organizational viability before start-up.
- Understand your competition and its appeal to providers, and define essential actions to keep your workforce;
- Assess your infrastructure and identify what you need for Value-Based Care Technology;
- Clarify criteria for APM selection, determine where to start your efforts and how much risk you can take;
- Craft your negotiation strategy with payers without leaving your most important asset on the table;
- Create a clinician network that will align with your population and goals, and engage them in leading clinical innovation;
- Appeal to consumers and patients by giving them the access and respect they need;
- Make clinical interventions your pinnacle achievement to improve outcomes and cost performance through data- and clinician-driven strategies.
Here’s what you’ll learn: