ALTERNATIVE PAYMENT MODEL (APM) FRAMEWORK - Final White Paper - Written by Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group

Oct 22, 2026

Uploaded by noah

Alternative Payment Model (APM) Framework Final White Paper outlines how a Health Care Payment Learning & Action Network (LAN) supports alignment in payment approaches across public and private sectors of the U.S. health care system. Convened by the CMS Alliance to Modernize Healthcare (CAMH) with the MITRE Corporation as operator, the Alternative Payment Models Framework and Progress Tracking Work Group defines principles and an APM Framework to track payment reform progress. It argues for moving beyond fee-for-service to shared risk and population-based payment to enable person-centered care through quality, cost effectiveness, and patient engagement.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Executive Summary

Overview

Health Care Payment Learning & Action Network (LAN)

The Case for Reforming the Health Care Payment System

Purpose of the White Paper

Approach

Key Principles for the APM Framework

The APM Framework

Conclusion

Stakeholders and the APM Framework

Appendix A: Work Group Members and Staff

ALTERNATIVE PAYMENT MODEL (APM) FRAMEWORK Final White Paper Written by: Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group For Public Release Version Date: 1/12/2016 Table of Contents Table of Contents .......................................................................................................................................... 1 Executive Summary....................................................................................................................................... 1 Overview ....................................................................................................................................................... 3 Health Care Payment Learning & Action Network (LAN) ......................................................................... 3 The Case for Reforming the Health Care Payment System ...................................................................... 4 Purpose of the White Paper ..................................................................................................................... 6 Approach .................................................................................................................................................. 6 Key Principles for the APM Framework ........................................................................................................ 7 The APM Framework .................................................................................................................................. 12 􀁮 Fee for Service with No Link to Quality & Value (Category 1): .......................................................... 14 􀁯 Fee for Service Linked to Quality & Value (Category 2): .................................................................... 14 􀁰 APMs Built on Fee for Service Architecture (Category 3): ................................................................. 15 􀁱 Population Based Payment (Category 4): .......................................................................................... 16 Conclusion ................................................................................................................................................... 18 Stakeholders and the APM Framework.................................................................................................. 18 Appendix A: Work Group Members and Staff ............................................................................................ 19 Work Group Chair ................................................................................................................................... 19 Work Group Members ............................................................................................................................ 19 CMS Alliance to Modernize Healthcare (CAMH) Staff............................................................................ 19 Catalyst for Payment Reform Staff (CPR) ............................................................................................... 21 Executive Summary The Health Care Payment Learning & Action Network (LAN) was created to drive alignment in payment approaches across the public and private sectors of the [U.S. health](U.S. health) care system. The CMS Alliance to Modernize Healthcare (CAMH), the federally funded research and development center operated by the MITRE Corporation, was asked to convene this large national initiative. To advance this goal, the Alternative Payment Models Framework and Progress Tracking Work Group (“the Work Group”) was charged with creating an alternative payment model (APM) Framework (“the APM Framework”) that could be used to track progress towards payment reform. Composed of diverse health care stakeholders, the Work Group has deliberated and reached consensus on many critical issues related to the classification of APMs, resulting in a rationale and a pathway for pa

FAQs

What is the purpose of creating the APM Framework and Progress Tracking work group?

The work group was charged with creating an Alternative Payment Model (APM) Framework that can track progress toward payment reform.

What three pillars define person-centered care in the white paper?

Person-centered care is described as resting on quality, cost effectiveness, and patient engagement.

Why does the white paper advocate moving away from fee for service (FFS)?

FFS inherently incentivizes higher service volume and can undervalue certain services, which the white paper argues is not conducive to delivering high-quality, cost-effective, person-centered care.

Oct 22, 2026

Uploaded by noah