Alternate Payment Models (APM Clause Samples

Alternate Payment Models (APM. BMS supports a value based health care system where member experience and population health are improved, the trajectory of health care cost is contained through aligned incentives with managed care organization and provider partners, and there is a commitment to continuous quality improvement and learning. To support this effort, the MCO is required to implement alternate payment models (APMs) that shift from fee-for-service reimbursement to reimbursement that rewards improved delivery of health care. In SFY 2018, the MCO is required to implement APMs that include ten (10) percent of members enrolled during the State Fiscal Year.. BMS intends to increase this target in future years. The MCO shall design and implement payment models with network providers that tie reimbursement to measureable outcomes. APMs may include, but are not limited to the following: 1. Primary care incentives; 2. Payment for performance; 3. Shared savings arrangements; 4. Risk sharing arrangements; 5. Episodes of care/bundled payments; and