Building alternative payment models in health care

Area of Science:

• Health Services Research
• Healthcare Management
• Health Economics

Background:

• Growing global interest in value-based healthcare models.
• Evidence gaps exist regarding alternative payment models (APMs) in early stages and private contracts.
• Need for understanding expert design and implementation of APMs.

Purpose of the Study:

• To update literature on APM design and implementation by industry experts.
• To identify key elements and stakeholders in APM development.
• To explore how APMs are practically designed and contracted.

Main Methods:

• Conducted a literature review to guide research.
• Employed snowball sampling to recruit 16 subject matter experts (SMEs).
• Performed 16 semi-structured interviews across the US, Netherlands, and Germany, analyzed thematically.

Main Results:

• Identified five key design themes: population/scope, data/technology, finance/incentives, provider partnerships, and leadership/regulation.
• Confirmed existing APM components and highlighted the importance of physician leadership and practice transformation.
• Found significant regulatory barriers related to data sharing and price-setting that hinder APM experimentation and success.

Conclusions:

• Physician leadership and practice transformation are critical for APM success.
• Policymakers must address regulatory hurdles in data sharing and pricing for APMs to thrive.
• Further research is needed to optimize APM design and implementation in diverse healthcare settings.