An innovative approach to healthcare reimbursement that diverges from traditional fee-for-service models. APMs aim to promote high-quality, cost-effective care by tying payment to value and outcomes rather than the volume of services provided.
A healthcare delivery model that prioritizes patient outcomes and overall health improvement. In APMs, providers are rewarded for delivering high-quality care that enhances patient well-being and reduces unnecessary healthcare costs.
A payment structure where healthcare providers receive a fixed amount per patient per unit of time, regardless of the specific services provided. This encourages providers to focus on preventive care and cost-effective treatments.
A reimbursement model where a single payment is made to cover all services related to a particular episode of care. This approach encourages coordination among healthcare providers and discourages unnecessary procedures.
A concept where healthcare providers are eligible to receive a portion of the cost savings generated through their efforts to deliver efficient and effective care. This encourages collaboration and cost-conscious decision-making.
A group of healthcare providers who voluntarily come together to coordinate care for a defined population. ACOs are often involved in shared savings arrangements and are held accountable for the quality and cost of care provided.
A care delivery model that emphasizes comprehensive and coordinated care, with the patient at the center. In APMs, PCMHs often serve as a primary point of contact, focusing on preventive care and management of chronic conditions.
A specific healthcare event or condition for which a patient seeks treatment. APMs often target episodes of care to encourage efficiency, cost-effectiveness, and quality improvement.
The process of modifying payments based on the health status and characteristics of a patient population. Risk adjustment helps ensure that APMs account for the varying complexity and needs of different patient groups.
Performance measures used to assess the quality of care provided by healthcare providers. APMs often tie financial incentives to achieving specific quality metrics to ensure the delivery of high-value care.
The use of technology to provide healthcare services remotely. APMs may leverage telehealth to improve access to care, especially in underserved or remote areas.
The practice of aligning financial incentives across healthcare stakeholders to promote shared goals, such as improved patient outcomes and cost savings. In APMs, incentive alignment is crucial for fostering collaboration among providers.