Healthcare Economist September 24, 2024
Jason Shafrin

Out of more than 50 alternative payment models (APM) that CMS has implemented only six have shown statistically significant cost savings and only four of these met the requirements to be expanded in duration and scope. That is not my opinion, CMS itself states this. We all want higher quality at lower cost; so the question is, why aren’t APMs delivering what was promised?

A Health Affairs Forefront piece by Patel, Jain and Mate (2024) argue that improvement science can help to identify three key failures of the current APM. These failures include:

  1. Insufficient data on population-level health and risks that lead to erroneous assumptions about cost-saving strategies;
  2. Misaligned or insufficient incentives that discourage providers from making favorable cost-saving...

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Topics: CMS, Govt Agencies, Insurance, Medicare, Payment Models, Provider, Value Based
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