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Featured Clinical Reviews

February 20, 2018

Principles for a Framework for Alternative Payment Models

Author Affiliations
  • 1USC Schaeffer Center for Health Policy and Economics, Los Angeles, California
  • 2Margolis Center for Health Policy, Duke University, Washington, DC
  • 3MITRE Corporation, Windsor Mill, Maryland
JAMA. 2018;319(7):653-654. doi:10.1001/jama.2017.20226

The way physicians, hospitals, and other health care professionals are paid influences patient care because payment methods affect business models that clinicians and health care facilities use to prioritize investments, establish infrastructure, and design care processes. Fee-for-service medicine and its volume-based financial incentives can lead to overuse of low-value services and suboptimal care. A consensus is emerging among patients, health care professionals, payers, and purchasers that transitioning to alternative payment models (APMs) that better incentivize value for patients is essential for improving the quality and affordability of health care. This is evidenced by bipartisan support for the Medicare Access and CHIP Reauthorization Act (MACRA); numerous models from the CMS Innovation Center; the activities of the Physician-Focused Payment Model Technical Advisory Committee; and the achievements of states, private plans, and hospitals and physicians nationally. As health care organizations prioritize the transition to APMs, it is increasingly important to use consistent terminology about stages along the APM pathway and common methods for measuring progress. Frameworks that classify APMs serve both of these purposes.

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