CHQPR, Harold D. Miller, December 6, 2018

Designing Value-Based Payments That Support  Affordable, High-Quality Healthcare Services

WHAT IS AN ALTERNATIVE PAYMENT MODEL?

There is broad consensus that fee-for-service payment is a major reason why healthcare spending has grown faster
than inflation without any corresponding improvement in the quality of care for patients. To address this, the
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) authorized the creation of “Alternative Payment
Models” in Medicare. In general, an APM must either:

• improve the quality of care without increasing spending;
• reduce spending without reducing the quality of care; 
or
• improve the quality of care and reduce spending.

As of 2018, the majority of healthcare providers in the country were not participating in

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