Richard Self, MD, MBA, and Janis Coffin, DO, FAAFP, FACMPE
With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May 2016, it has become of interest to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access & CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor performance relative to their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of three of the fully qualifying Advanced APMs: the Next Generation Accountable Care Organization Model, the Oncology Care Model, and the Comprehensive ESRD Care Model. Although these programs are closed to entry in the foreseeable future, their principal operating guidelines serve as a template for future models being developed. Thus, understanding the make-up of these models may better inform practices and organizations seeking participation in either a simple or Advanced APM for the 2018 reporting period and beyond.