Advanced Alternative Payment Models

For Alternative Payment Models (APMs) to allow Medicare clinicians to qualify for incentive payments, clinicians would have to receive enough of their payments or see enough of their patients through Advanced APMs. Advanced APMs are the CMS Innovation Center models, Shared Savings Program tracks, or statutorily required demonstrations where clinicians accept both risk and reward for providing coordinated, high-quality and efficient care. The final rule includes a list of models that would qualify as Advanced APMs.

APMs participants who are not in Advanced APMs will be required to participate in MIPS and will receive favorable scoring in certain MIPS categories.

  • The APM requires participants to use certified EHR technology.
  • The APM bases payment on quality measures comparable to those in the MIPS Quality performance category.
  • The APM either: (1) requires APM entities to bear more than nominal financial risk for monetary losses; OR (2) is a Medical Home Model expanded under CMMI authority.

APMs or Advanced APMs

If participating in Medicare Shared Savings Track 1
you will be required to participate in MIPS

CMS-approved Advanced APMs

Comprehensive ESRD Care Model

(currently 13 ESCOs)

Comprehensive Primary Care Plus

(coming in Fall 2016)

Medicare Shared Savings Track 2

(currently 6 ACOs, 1% of total)

Medicare Shared Savings Track 3

(currently 16 ACOs, 4% of total)

Next Generation ACO Model

(currently 18)

Oncology Care Model, 2-sided Risk Arrangement

(coming in 2018)