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 is 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. Over the course of the next several months, the task force will be developing a set of toolkits focused on six primary components of an administrative infrastructure: Governance; Program Administration and Operations; Information Management; Contractual Relationships; Revenue Cycle and Financial Management, and Clinical and Administrative Integration.
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.
The task force’s offerings will begin with three toolkits: Governance; Information Management; and Program Administration and Operations. Contractual Relationships, Revenue Cycle and Financial Management, and Clinical and Administrative Integration will be added in the spring of 2018.
If you have suggestions on how we might improve one or more of the checklists, or if you would like to suggest or offer content, please contact Pam Jodock, Senior Director of Health Business Solutions at firstname.lastname@example.org.
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.