Conference Lessons on Alternative Payment Model (APMs)
| Lessons for policymakers | APMs 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 payors | The 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 researchers | We 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 providers | APMs 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.