The Path to Successful Utilization of Alternative Payment Models

I. Introduction

The U.S. healthcare system is in the process of shifting from traditional fee-for-service (FFS) payment to value-based alternative payment models (APMs).¹  The number of APMs were significantly accelerated by the Patient Protection and Affordable Care Act (PPACA), which established the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs).² Ten years after the passage of PPACA, and five years after the passage of the Medicare Access and CHIP Reauthorization Act (MACRA),³ the evolution of these value-based reimbursement (VBR) models may provide some insight as to the future success of these arrangements. Toward that end, this article reviews recent trends and changes to federal, quasi-federal, and private APMs, and discusses the indications that may be drawn from these developments.