Alternative Payment Methods


Alternative Payment Methods include

  • Global payments
  • Limited budgets
  • Bundled payments
  • Other non-FFS based payments

For More Information on Alternative payment methods
see CHIA's 2016 Annual Report

chia annual report 2016 cover

Alternative Payment Methods (APM)
Publication Materials (March 2016)

Alternative Payment Methods Chartbook

The Center for Health Information and Analysis (CHIA) collects and reports data on Alternative Payment Methods (APMs). APMs are methods of payment used by payers to reimburse providers not solely based on a fee-for-service (FFS) basis in which some of the financial risk associated with both the occurrence of medical conditions as well as the management of those conditions is shifted from payers to providers to incentivize efficiency and quality of health care delivery. With the enactment of Chapter 224 of the Acts of 2012, CHIA is statutorily mandated to collect and report APM data from private and public health care payers operating in the Massachusetts health care market.

While FFS remains the dominant type of payment method utilized in the Commonwealth, APMs have been implemented in recent years among commercial, Medicaid, and Medicare populations.

 

Key Findings from the 2016 annual report

  • The proportion of members whose care was paid for using APMs in the Massachusetts commercial market declined 1.9 percentage points to 35.1%.

  • MassHealth MCOs reported a 0.6 percentage point increase in APM adoption to 32.0%, after declining from 2013 to 2014.

  • APM adoption in the MassHealth PCC plan grew to 23.0% of members in 2015, an increase of 1.3 percentage points over the prior year.

 

 Alternative Payment Methods (APMs) in Massachusetts

Previous Alternative Payment Methods Publication Materials