Adapting Evaluations of Alternative Payment Models to a Changing Environment

Area of Science:

• Health Services Research
• Health Economics
• Healthcare Policy

Background:

• The healthcare landscape is rapidly evolving with the widespread adoption of alternative payment models (APMs).
• Traditional research designs struggle to establish credible comparison groups in this dynamic environment.
• Evaluating the effectiveness of APMs is crucial for healthcare reform.

Purpose of the Study:

• To identify the most robust methods for evaluating alternative payment models (APMs).
• To assess the impact of APM adoption on the availability of credible comparison groups.
• To consider the applicability of factorial research designs for APM evaluation.

Main Methods:

• Assessing the impact of widespread APM testing on comparison group availability.
• Evaluating the applicability of factorial research designs for APM assessment.
• Comparing factorial experiments with traditional single-model designs.

Main Results:

• Widespread APM adoption challenges the use of "pure" control or comparison groups.
• Factorial experiments present advantages over traditional designs in the current healthcare environment.
• Systematically varying APM requirements and provisions within experiments is key.

Conclusions:

• Fractional factorial experiments are the most promising approach for definitive APM evidence.
• These experiments allow systematic variation of payment incentives and model requirements.
• Robust evaluation methods are essential for understanding APM impacts.