Alternative Payment Models

THE APM FRAMEWORK

This Framework represents payments from public and private payers to provider organizations (including payments between the
payment and delivery arms of highly integrated health systems). It is designed to accommodate payments in multiple categories
that are made by a single payer, as well as single provider organizations that receive payments in different categoriespotentially
from the same payer. Although payments will be classified in discrete categories, the Framework captures a continuum of
clinical and financial risk for provider organizations.

CATEGORY 1 CATEGORY 2 CATEGORY 3 CATEGORY 4

FEE FOR SERVICE FEE FOR SERVICE APMS BUILT ON POPULATION
NO LINK TO LINK TO QUALITY FEE-FOR-SERVICE BASED PAYMENT
QUALITY & VALUE & VALUE ARCHITECTURE

A A A
Foundational Payments APMs with Condition-Specic
for Infrastructure Shared Savings Population-Based
& Operations (e.g., shared savings with Payment
(e.g., care coordination upside risk only) (e.g., per member per month
fees and payments for payments, payments for
HIT investments) B specialty services, such as
oncology or mental health)
APMs with
B Shared Savings
Pay for Reporting and Downside Risk B
(e.g., bonuses for reporting (e.g., episode-based Comprehensive
data or penalties for not payments for procedures Population-Based
reporting data) and comprehensive Payment
payments with upside (e.g., global budgets or
C and downside risk) full/percent of premium
payments)
Pay-for-Performance
(e.g., bonuses for quality C
performance)
Integrated Finance
& Delivery Systems
(e.g., global budgets or
full/percent of premium
payments in integrated
systems)

3N 4N
Risk Based Payments Capitated Payments
NOT Linked to Quality NOT Linked to Quality

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