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The year 2021 has been a dramatic one for the evolution of alternative payment models (APMs) in U.S. healthcare, from every type of accountable care organization (ACO) to bundled payments, to the rollout of the Direct Contracting program for physician groups under Medicare. That has been true both in the public and private spaces, but policy changes on the federal level have involved the most dramatic developments.
To begin with, one must start with the change in administrations. The change from the Trump administration to the Biden administration in January was dramatic. Out was Health and Human Services Secretary Alex Azar, and in was new HHS Secretary Xavier Becerra, formerly the California Attorney General. Out went Administrator of the Centers for Medicare and Medicaid Services Seema Verma, and in came new CMS Administrator Chiquita Brooks-LaSure. Out went Brad Smith, who had served only one year as Director of the Center for Medicare and Medicaid Innovation (CMMI), himself replacing Adam Boehler, who had served in the post from April 2018 until January 2020; and in came Elizabeth Fowler, Ph.D. The shifts in personnel reflected a dramatic shift in focus and, frankly, ideology.