APMs

Question 1

What is HCP-LAN

Answer 1

Health Care Payment Learning & Action Network.

Question 2

What is the APM Framework

Answer 2

Alternative Payment Model Framework.
Created by CMS and modified by HCP-LAN
Payment Model Classification System
Consists of 4 Categories with up to 3 subcategories each. The categories map the path towards person-centered payment reform

Question 3

APM Category 1

Answer 3

Fee for Service
No link to quality & value

Question 4

APM Category 2

Answer 4

Fee for Service + Link to Quality & Value
Includes 3 subcategories:
A. Foundational Payments (e.g. care coordination fees, technology investments)
B. Pay for Reporting (e.g. bonuses for reporting data, penalties for not reporting)
C. Pay for Performance (e.g. bonuses for quality performance)

Question 5

APM Category 2A

Answer 5

Foundational Payments (e.g. care coordination fees, technology investments)

Question 6

APM Category 2B

Answer 6

Pay for Reporting (e.g. bonuses for reporting data, penalties for not reporting)

Question 7

APM Category 2C

Answer 7

Pay for Performance (e.g. bonuses for quality performance)

Question 8

APM Category 3

Answer 8

Alternative Payment Models built on Fee for Service Architecture
Includes 2 subcategories:
A. APMs with Shared Savings (e.g. shared savings with upside risk only)
B. APMs with Shared Savings and Downside Risk (e.g. episode based payments for procedures, comprehensive payments with upside and downside risk)

Question 9

APM Category 3A

Answer 9

APMs with Shared Savings (e.g. shared savings with upside risk only)

Question 10

APM Category 3B

Answer 10

APMs with Shared Savings and Downside Risk (e.g. episode based payments for procedures, comprehensive payments with upside and downside risk)

Question 11

APM Category 4

Answer 11

Population Based Payment
3 subcategories:
A. Condition Specific Population Based Payment (per member per month payments, payments for specialty services such as oncology or mental health)
B. Comprehensive Population Based Payment (e.g. global budgets or full/percent of premium payments)
C. Integrated Finance & Delivery Systems (e.g. global budgets or full/percent of premium payments in integrated systems)

Question 12

APM Category 4A

Answer 12

Condition Specific Population Based Payment (per member per month payments, payments for specialty services such as oncology or mental health)

Question 13

APM Category 4B

Answer 13

Comprehensive Population Based Payment (e.g. global budgets or full/percent of premium payments)

Question 14

APM Category 4C

Answer 14

Integrated Finance & Delivery Systems (e.g. global budgets or full/percent of premium payments in integrated systems)