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Success of APMs Depends on Infrastructure Support

If you save money on the clinical side, but triple your administrative costs, you will not have achieved your goal of cost containment.

This has been my mantra since alternative payment models (APMs) began being touted as the Golden Ticket for meeting healthcare’s Triple Aim. 

Understanding Alternative Payment Models

The technology and business processes in place today were designed to support our historical fee-for-service delivery model. They did not contemplate the level of information sharing, data analytics and quality reporting inherent in today’s emerging APMs; they cannot be easily tweaked to accommodate these new demands. 

The rate of APM adoption has quickly outpaced our ability to develop the technical solutions and business processes to support them.  Those organizations participating in one or more APMs, and with deep enough pockets to do so, are developing internal solutions; those with fewer resources or less sophisticated operations find themselves awash in manual work-arounds that lead to decreased efficiency and increased administrative costs. 

With the essential mission provide global leadership for the optimal use of IT and management systems for the betterment of healthcare, HIMSS recognizes that without the technology needed to support them, APMs are endanger of becoming the last great thing that couldn’t save the American healthcare system. We are cognizant of:

  • Recent studies declaring administrative tasks the primary cause of burnout for physicians
  • Research conducted in 2011 indicating, even before the introduction of APMs, for every physician in the US, there were 2.2 administrative workers.

These concerns led to the creation of the HIMSS Alternative Payment Model Infrastructure Task Force in July 2016. This task force provides guidance on the administrative infrastructure necessary to support APMs and has identified six structural areas of focus: 

  • Governance
  • Program Administration and Operations
  • Information Management
  • Finance/Revenue Cycle Management
  • Contracting
  • Clinical Integration
APMs have the potential to transform the way healthcare is delivered in this country, and increase patients' engagement in their health…

…But only if we ensure they have the right chassis to support them.  Working together as a community, we can make sure that happens.

Resources from the HIMSS Alternative Payment Model Infrastructure Task Force

I invite you to visit the APM webpage, check out the checklists and resources, and let me know what you think.  If you have content you would like to contribute, I would love to hear from you.  Simply reach out to Pam Jodock at pjodock@HIMSS.org to schedule a call.

From HIMSS

  • Three toolkits available on this webpage.  The remaining three will be introduced over the next several months.

From outside resources

Keywords: 
alternative payment models