McKinsey January, 2019
Marc Berg, David Nuzum, and Seema Parmar

To aid APM (re)design and support providers and payers in their value-based contracting strategy, this paper highlights seven characteristics that distinguish well-performing APMs from poorly performing models.

Executive Summary

Alternative payment models (APMs) are central to the efforts to reduce the growth in healthcare costs and improve outcomes for patients. Yet some stakeholders remain skeptical of their potential. This is understandable, because APMs have shown mixed results. We have identified seven characteristics of well-designed models that yield meaningful savings for payers, improve margins for high-value providers, and improve patient outcomes.

1. Density and scale

For an APM to succeed, the proportion of the provider’s book of business included in the model must be sufficiently large (high density) to motivate...

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Topics: CMS, Govt Agencies, Health System / Hospital, Insurance, Medicaid, Medicare, Patient / Consumer, Payer, Payment Models, Physician, Primary care, Provider, Value Based
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