5 Signs of a Successful APM
Tips for selecting the right Alternative Payment Model
As the MACRA legislation begins its implementation this year, many health care providers, practices and healthcare systems are researching their options for Medicare and Medicaid reimbursement programs. Alternative Payment Models (APMs) are one available solution., and are appealing to many providers as there are opportunities for additional incentives or a higher percentage of reimbursements paid. These opportunities exist because members of these groups must take additional steps to increase the quality of care provided, while also reducing the cost of that care.
Not all APMs are the same, and some can potentially put doctors and their patients at risk, by placing the cost of care above the quality of care and vice versa. To address current pitfalls and prevent future problems, The American Journal of Accountable Care has published 5 key principles for APM stakeholders and the development of successful programs. Main Street Medical Solutions’ experts break down the 5 key principles in this post, so that you know what to look for when joining a successful and supportive APM.
5 Key Principles to look for in an APM:
1. APMs should make available the resources needed, for practitioners to provide high value care.
APMs that offer high value, but low cost services such as patient education services, that can help patients with long term care issues avoid higher cost treatment such as hospital stays are ones that should be considered.
2. APMs should only hold health care providers responsible for factors (both quality and cost) that they can control.
Physicians can’t always control the actions of other physicians, or the cost of prescription medications. APMs that take these situations into consideration, rather than promoting the avoidance of high cost or high risk patients are more likely to help physicians than harm them.
3. While Primary care is an important focus, these APMs should also provide payment/reimbursements for specialty care.
Not all primary care can prevent all acute health issues, and some patients will need to seek specialty care practices for the treatment of different ailments. In some APMs there is a barrier for primary care physicians to work with specialists. Take care to choose an option that will foster work with specialists and other health care providers.
4. APMs should be flexible and take into account the differences in localized care across different regions of the US.
Geography plays a major role in the care available to certain patients, and their physicians. For example, those in more rural areas will have to drive farther, to seek specialists who may not be in network, for treatment. Take a look at different APMs and choose one that will offer you and your patients flexibility in care and treatment options.
5. APMs should focus on minimizing the amount of administrative burdens placed on health care providers.
Many recognize that the complexity of the current and previous systems in place for managing care have actually contributed to make it even more costly. A good APM focuses on reducing the burden for the practices who subscribe to it.