Governance Toolkit

Each toolkit will include a definition of the area being addressed, a checklist of recommended activities for that area an organization should consider in their move from fee-for-service to pay-for-value, and tools and resources associated with each line item. These toolkits, and the checklists associated with them, will grow and change as more information and resources become available, and as we respond to feedback received from those who access them.

For the purposes of this HIMSS Alternative Payment Model (APM) Infrastructure Tool Kit, APM Governance refers to the set of processes, policies, technology and regulations applied to an APM entity to ensure its successful execution of its mission and long-term viability within the community it serves.  Governance includes consideration of the complex relationships necessary to support the APM entity’s operations, including those among and between internal and external practitioners, specialty groups, healthcare facilities, durable medical equipment (DME) and pharmaceutical providers, commercial and governmental payers, regulatory authorities, and the community at large. Activities that fall within the scope of APM Governance include:

  • Set the Vision and Strategic Objectives
  • Assure processes are in place to implement and monitor regulatory compliance and protect against fraud, waste and abuse
  • Engender corporate culture and formalize rules of engagement
  • Ensure proper representation of appropriate stakeholder groups throughout the organizational structure
  • Establish decision-making processes
  • Ensure stakeholder alignment with Strategic Objectives across the organization
  • Develop risk appetite and level of tolerance and alignment with Strategic Objectives
  • Monitor the company’s strategic, operational, financial, and technology performance and compliance exposure for risk and act accordingly