[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-198736-105":53,"doc-detail-198736-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","aha-vbm-payment-approaches-barriers-and-implementation-strategies","AHA VBМ Payment Approaches - Barriers and Implementation Strategies","","Payment approach categories and example models describe how value-based payment reforms have been demonstrated, piloted, and implemented across episodic, primary care-focused, and specialized care-focused longitudinal settings. The material highlights typical clinical episode examples (e.g., valve surgery, PCI, pacemaker implantation, CABG, heart failure hospitalization) and the associated contracting structures, including prospective payment with two-sided risk and shared savings/losses, plus mixed retrospective-prospective arrangements. It also outlines implementation barriers and practical strategies, such as building an appropriate workface, securing physician buy-in, enabling flexibility in care team coordination, addressing low-resource constraints via telehealth and technical assistance, applying implementation science, and reducing provider burden by managing overlap and phased rollout.",{"@graph":63,"@context":123},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":11,"@type":70,"position":76},"https://docshare.wps.com/template/presentations/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/aha-vbm-payment-approaches-barriers-and-implementation-strategies/198736/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/aha-vbm-payment-approaches-barriers-and-implementation-strategies/198736.png","ImageObject",442,249,{"name":88,"@type":89},"Skyler","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-11","2026-09-04",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115,119],{"name":106,"@type":107,"acceptedAnswer":108},"Which payment approach categories are discussed and how are they grouped?","Question",{"text":109,"@type":110},"The document groups approaches into episodic models, primary care-focused longitudinal models, and specialized care-focused longitudinal models, each with example programs and target populations or clinical contexts.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What kinds of contracting structures are used across the example payment models?",{"text":114,"@type":110},"Examples include prospective payment with two-sided risk, shared savings/losses, per-beneficiary payments tied to risk stratification and performance based on risk reduction, and arrangements that mix retrospective and prospective elements.",{"name":116,"@type":107,"acceptedAnswer":117},"What barriers are identified for implementing major value-based payment (VBP) models?",{"text":118,"@type":110},"Key barriers include building an appropriate workface and achieving physician buy-in, implementing major culture change, and overcoming challenges in low-resource settings.",{"name":120,"@type":107,"acceptedAnswer":121},"What strategies does the document recommend to overcome implementation barriers?",{"text":122,"@type":110},"Recommended strategies include allowing flexibility in clinician coordination and care team composition, using multi-level coordinated efforts for culture change, leveraging telehealth for workforce shortages, providing upfront capital and technical assistance to smaller organizations, and applying an implementation science approach for program testing and rollout.","https://schema.org",{"og:url":78,"og:type":125,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":127,"canonical":78},"index,follow",{"doc_id":129,"site_id":56},198736,1788486356,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":88,"user_avatar":134,"doc_module":9,"category_id":8,"category_name":11,"doc_title":59,"doc_description":61,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":140,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":141,"language":142,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":143,"faqs":144,"seo_title":145,"seo_description":61,"update_tm":130,"read_time":47},2336464648746,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","| Payment Approach Category | Example Alternative Payment Model | Focus (Procedure, Condition, Population) | Years of Existence | Payment Approach |\n| --- | --- | --- | --- | --- |\n| Episodic models | Medicare Acute Care Episode19 | Valve surgery, defibrillator implants, CABG, pacemakers, PCI | Demonstration (2009–2012) | Prospective payment with 2-sided risk |\n|  | Cleveland Clinic and Boeing/ Lowe’s/Walmart20 | Valve surgery | Private sector partnership started between 2010 and 2012 | Prospective payment with 2-sided risk |\n|  | Integrated Healthcare Association21 | Cardiac catheterization | Pilot launch in 2012 | Prospective payment with 2-sided risk |\n|  | Medicare BPCI initiative22 | Examples: PCI, pacemaker, ICD, valve surgery, CABG, HF hospitalization and recovery | Demonstration between 2013\u003Cbr>and 2016; BPCI-Advanced in progress now18 | Mix of retrospective and prospective payment and 1-and 2-sided risk |\n|  | Arkansas Healthcare Payment Improvement Initiative23 | Heart failure hospitalization and recovery | Pilot beginning 2012, finalized design in 201924 | Retrospective payment with incentive payment or 2-sided risk |\n| Primary care-focused\u003Cbr>longitudinal models | Medicare Shared Savings Program25 | General Medicare population (contains HF quality measures) | Program (2012–current) | Shared savings/losses |\n|  | Million Hearts: Cardiovascular Disease Risk Reduction Model26 | Medicare population without previous heart attack, stroke, or transient ischemic attack | CMMI model 2017–2022 | Per-beneficiary payment for risk stratification and performance payment based on risk reduction |\n| Specialized care-focused longitudinal models | Atlanta Value-Based Health Care Pilot27 (underdevelopment) | Late-stage HF patients at risk of readmission who may benefit from palliative care | Details not yet announced (currently under development) | Details not yet announced (currently under development) |\n\n| Barriers/Considerations for Implementation | Strategies to Overcome Barriers, Examples |\n| --- | --- |\n| Building an appropriate workface and gaining physician buy-in | Allowing flexibility on clinician coordination and care team composition can accommodate differing care team mixes and allow for innovative care pathways |\n|  | A multi-level, coordinated strategy to enact culture change is needed to implement a major VBP model |\n| Implementation in low resource settings | Telehealth could allow for remote consultations to address workforce shortages |\n|  | Providing upfront capital and technical assistance to smaller, more fragmented, and rural organizations could help facilitate their success |\n| Using implementation science | Look to previous examples of success in implementing payment reform |\n|  | Consider an implementation science approach to program testing and rollout |\n| Managing model overlap and model development | Align with preexisting models, partner with innovative plans, clinicians, and value-based help organizations to reduce provider burden |\n|  | Start with a limited number of steps and expand over time |","cbCaireQqhUgIuC4","https://ap.wps.com/l/cbCaireQqhUgIuC4","pdf",670293,8,13,"English","# Payment Approach Categories\n## Episodic models\n## Primary care-focused longitudinal models\n## Specialized care-focused longitudinal models\n# Barriers and Implementation Strategies\n## Building workface and physician buy-in\n## Low-resource implementation support\n## Implementation science and program testing\n## Managing model overlap and rollout","[{\"question\":\"Which payment approach categories are discussed and how are they grouped?\",\"answer\":\"The document groups approaches into episodic models, primary care-focused longitudinal models, and specialized care-focused longitudinal models, each with example programs and target populations or clinical contexts.\"},{\"question\":\"What kinds of contracting structures are used across the example payment models?\",\"answer\":\"Examples include prospective payment with two-sided risk, shared savings/losses, per-beneficiary payments tied to risk stratification and performance based on risk reduction, and arrangements that mix retrospective and prospective elements.\"},{\"question\":\"What barriers are identified for implementing major value-based payment (VBP) models?\",\"answer\":\"Key barriers include building an appropriate workface and achieving physician buy-in, implementing major culture change, and overcoming challenges in low-resource settings.\"},{\"question\":\"What strategies does the document recommend to overcome implementation barriers?\",\"answer\":\"Recommended strategies include allowing flexibility in clinician coordination and care team composition, using multi-level coordinated efforts for culture change, leveraging telehealth for workforce shortages, providing upfront capital and technical assistance to smaller organizations, and applying an implementation science approach for program testing and rollout.\"}]","AHA VBМ Payment Approaches - Barriers and Implementation Strategies | PDF"]