Health Affairs September 20, 2024
Since the passing of the Patient Protection and Affordable Care Act (ACA) in 2010, the Center for Medicare and Medicaid Innovation (CMMI) has piloted more than 50 alternative payment models (APMs) designed to improve care across a spectrum of conditions and populations while transitioning away from fee-for-service reimbursement schemes. To date, however, only four of these APMs have been expanded for reducing net spending or improving the quality of patient care. These results ought to catalyze policymakers to seek out innovative approaches to payment reform that can overcome existing challenges.
CMMI’s current approach to developing APMs are challenged by three primary failure modes: (1) insufficient data on population-level health and risks that lead to erroneous assumptions about cost-saving strategies; (2)...
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