Table 1.

Conference Lessons on Alternative Payment Model (APMs)

Lessons for policymakersAPMs are falsely promoted as a panacea for health system problems. They should instead be seen as kindling for ongoing primary care innovation within a continuous learning health system.
Regardless of the APM chosen, overall spending on primary care must increase to achieve health system aims.
Lessons for payorsThe small-scale and unsustainable design of many APM pilot programs creates payor “pilotitis.” Both countries must foster “learning at scale,” as demonstrated in the US CPCI.
Canada needs an innovation center like the US' CMMI to foster and evaluate scaled payment experiments across a provincial delivery models.
Lessons for researchersWe need more robust evaluation released more rapidly, with stronger comparison groups, and increased transparency of results.
We need evaluations of how APMs promote or inhibit health equity. For example, how can we adjust for variation in SDoH without excusing poor quality?
Lessons for providersAPMs that promote flexibility and pursuit of end outcomes over process measures increase both patient satisfaction & primary care provider wellness.
Practices cannot bear all transformation risk, and require prospective, preferably population-based payment, i.e. capitated or blended payment.
  • CMMI, Center for Medicare and Medicaid Innovations; CPCI, Comprehensive Primary Care Initiative SDoH, Social Determinants of Health.