Developing Alternative Payment Models: Key Considerations and Lessons Learned from Years of Collaboration with CMS

Issue Brief
Publisher: Washington, DC: Mathematica Policy Research
Oct 21, 2015
Authors
Mary Laschober, Eugene Rich, Timothy Lake, Angela Merrill, and Candace Natoli

In an effort to control health care spending while improving service quality and access, private and public payers are experimenting with innovative ways to reimburse health care providers. The Centers for Medicare & Medicaid Services (CMS), for example, has invested significant resources to move away from traditional fee-for-service (FFS) payment toward alternative payment models that reward efficient, high quality, and patient-centered care. These shifts, though, often require substantial policy, structural, and operational changes at every level of service delivery. Fortunately, evidence is available to help program leaders and managers, health care system leaders, and policymakers design, implement, and evaluate new value-based payment approaches.