Evaluating and Assessing Medicare Advanced Alternative Payment Models


Over the past decade, Medicare's payment and delivery reform initiatives have been helping to move the U.S. health care system to reward value over volume. The establishment of the Center for Medicare and Medicaid Innovation has accelerated the type and number of innovative models being tested, while Medicare's implementation of value-based payment for physicians should spur additional innovation in alternative payment models (APMs). Notwithstanding this progress, there have been few attempts to foster a common understanding among policymakers and stakeholders about the design and features of APMs. This project will develop a matrix to enable comparison of the critical design features of advanced APMs — the subset of APMs authorized as a value-based payment pathway for physicians under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). (An estimated 25 percent of physicians will be in advanced APMs in 2018.) First, the CapView team will conduct a literature review and stakeholder interviews to identify critical design features of APMs that show evidence or promise to change cost and quality outcomes. Next, the team will develop a matrix for comparing features of advanced APMs and refine it based on stakeholder and expert feedback. The matrix will then be populated with information on advanced APMs to create a searchable database. Data will be derived from publicly available federal sources, provider and payer reports, third-party publications, and peer-reviewed literature. CapView will solicit additional feedback on the matrix to determine optimal variables and formats. The matrix will help policymakers better understand the landscape of Medicare advanced APMs. It may also help physician groups and health system leaders develop APMs with new, desirable features. This comparative tool may serve as a prototype for comparing information regarding the overall Medicare APM landscape or other sets of value-based initiatives.

Grant Details

Grantee Organization:
CapView Associates, LLC
Principal Investigator:
Purva Rawal, Ph.D.
Award Amount:
Approval Date:
April 11, 2017

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