Alternative Payment Models (APMs) have been promoted by the Center for Medicare and Medicaid Innovation as options that can help reduce costs while maintaining and improving patient outcomes. Now into its second decade, CMMI continues to improve and expand APMs in order to drive growth and transformation in the health care system.

APMs will continue to change in 2022 and beyond, and providers need to be prepared for the challenges that these changes will bring. CMMI has recently released a report outlining many of these coming changes, which include the development of fewer models, emphasizing health equity, reducing selection bias, and increasing provider participation.

The best way to prepare for these changes and the challenges they will undoubtedly bring is to learn from the past, and from providers that have already participated in APMs. These providers have learned many lessons that will bring great value to others looking to start participating. Those that have been participating have already faced some of the challenges inherent to these models, and considering these challenges is crucial to developing tools and workflows that can overcome similar problems in future models.

Here are 3 of the biggest challenges of alternative care models:

• Resource Constraints

Preparation for participating in an APM should begin at least 6 months in advance though in some cases 18 months might be better, prior to starting. Preparation is both labor-intensive and time-consuming, and it includes:

• Appoint a physician champion to support participation in the model and gain leadership buy-in.
• Learning about eligibility, practice transformation requirements, and model design.
• Assigning management and oversight responsibilities within the practice.
• Collecting, monitoring, and assessing data that is relevant to model participation.

The implementation of practice transformation activities will begin as soon as the program begins and practices must continue to regularly monitor and assess their data. Many changes will have to be made to processes and workflows within the practice to improve performance.

• Complex Rules and Policies

APMs bring with them an entirely new set of regulatory and policy requirements which can be very challenging for providers. These rules can be very complex, requiring providers to have a deep knowledge of the current payment system, the design of the new model, and how it will affect the practice and its patients. Participating in multiple APMs at the same time makes it even harder to keep up with all of these rules.

The rules surrounding quality measures are crucial for practices to stay on top. These rules can be challenging but they are very important to successful program participation. Progress towards the goals of the program must be continually tracked in order to assess compliance with the rules of the APM.

• Data Analysis and Modeling

Measuring data and monitoring changes is another challenge in successfully navigating an APM program. CMS provides feedback reports for some programs, but even then, the information is quite limited. The effectiveness of data as a tool for improving care and anticipating future financial impacts is restricted, making it necessary for providers to manage data on their own.

While EHRs can store a great deal of data that can be used to assess performance, they will lack data about all of the healthcare used by patients across the care continuum. Many healthcare organizations lack the manpower, expertise, and bandwidth needed for collecting, normalizing, and analyzing additional data sources outside of the EHR.