Alternative Payment Model Infrastructure Toolkits

The transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces1. While a great deal of attention has been paid to the clinical elements and payment methodologies associated with this change, little has been said about the administrative infrastructure required to support the move. 

Formed in July 2016, the HIMSS Alternative Payment Model Infrastructure (APMI) Task Force complements work developed  at the national level by groups such as the Health Care Payment Learning and Action Network (HCP LAN) and the Accountable Care Learning Collaborative (ACLC).  The task force was responsible for developing and socializing the administrative framework necessary to support an alternative payment model, including the technical functionality recommended to be embedded in this infrastructure.  Since inception, the task force developed a set of toolkits focused on six primary components of an administrative infrastructure:  Clinical and Administrative Integration; Contractual Relationships; Governance; Information Management; Program Administration and Operations; and Revenue Cycle and Financial Management. 

Each toolkit includes 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. 

Toolkits

Clinical and Administrative Integration

Contractual Relationships

Governance

Information Management

Program Administration and Operations 

Revenue Cycle and Financial Management

 

Additional Resources

American College of Cardiology APM Framework

Alternative Payment Model (APM) Framework

Delivery System Reform, Medicare Payment Reform

CAPG Website

CMS Website

AMA Website

 

1 - Brown, Bobbi and Jared Crapo.  “The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement.”  2014.  https://www.healthcatalyst.com/hospital-transitioning-fee-for-service-value-based-reimbursements.