Main Library

Hierarchical Payment Models—A Path for Coordinating Population- and Episode-Based Payment Models

January 14, 2022William H. Shrank, MD, MSHS; Michael E. Chernew, PhD; Amol S. Navathe, MD, PhD,JAMA NetworkBundled Payments,Alternative payment models (APMs)

In November 2021, the Centers for Medicare & Medicaid Services (CMS) announced a strategy to achieve near-universal participation in value-based payment models by 2030. Core to this strategy is the goal that every beneficiary should be in a clinical care relationship that has accountability for quality and total cost of care. Achieving this goal will require harmonizing the CMS foundational value-based payment models that focus on accountability across the continuum of care (ie, population-based models) with those that target specific diseases, acute events, or sites of care (ie, episode or bundled payment models).

With more than 20 ongoing value-based payment programs, models often overlap. This creates a complex environment for health care organizations to make decisions about participation, care redesign, and investments. This environment also limits the rigor of model testing. Isolating the effect of a model may be nearly impossible, leading to a situation in which singular models are not deemed successful despite contributing to system-level improvements in quality and cost.

Amidst this complexity, articulating how to coordinate population- and episode-based payments could serve to catalyze reform and focus payment and delivery system innovation, much in the way that then-Secretary Sylvia Mathews Burwell of the US Department of Health and Human Services did for value-based payments in 2015.

Full Article

: alternative payment models, APMs, Bundled Payments, CMS, value-based payment

Related Posts

Value-Based Payment Models Associated with Lower Acute Care Use

March 22, 2022aco

Provider Collaboration Needed to Drive Patient Experience, ACO Success

February 9, 2022aco

NAACOS Leaders Document Major MSSP Savings, Support Pro-ACO Legislation in Congress

August 25, 2021Garrett Schmitt

Recent Posts

  • Value-based care creating a new era of interoperability
  • ACO REACH And Advancing Equity Through Value-Based Payment, Part 1
  • Medicare Shared Savings Program: Celebrating 10 Years and Looking Forward to the Future
  • Considerations for Social Determinants of Health Screening Design
  • RECORDED WEBINAR: 5 Key Components for Organizational Growth Within Value-Based Care
 
  • Main Lobby
  • Exhibit Hall
  • Events
  • Exhibit With Us
  • Board Room
  • Library
  • Contact Us