What is an Alternative Payment Model?
An Alternative Payment Model (APM) is not the usual “fee for service” way of paying for discreet health care services. It is an innovative way to pay health care providers for delivering high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population, and in the case of HealthySteps, babies and toddlers.
How does APM relate to HealthySteps?
Our evidence-based model, paired with fidelity monitoring, makes HealthySteps–and HealthySteps practices–well-positioned for an APM. We developed an APM framework to support states, health plans, health systems, and pediatric primary care providers in developing an APM that supports a payment and measurement structure based on the dyadic HealthySteps model.
Why are APMs important for pediatric primary care?
Our current fee-for-service billing system is built on paying for a service delivered to a person with a diagnosis. Because so much of what we do in HealthySteps is prevention-focused, and many of our patients will not qualify for a diagnosis, we are not adequately paid. An APM works to remedy that by focusing on patient and family outcomes, improving health care delivery, and reducing the overall cost of care.
Who should you share this with?
You can use our framework to inform conversations with leadership at your practice or health system, insurers, and/or with your state Medicaid agency.