Funding received to quantitatively assess the impact of APM on service utilization, quality, and cost of healthcare

Authors: Heather Angier, Erika Cottrell, David Cameron

We are excited to report that our research team received funding from the Agency for Healthcare Research and Quality to conduct quantitative analyses assessing the impact of the innovative APM natural experiment. Led by Jen DeVoe, MD, DPhil, the Evaluating Community Health Centers’ Adoption of a New Global Capitation Payment (eCHANGE) project will utilize electronic health record and Medicaid claims data to study changes in service utilization, quality and cost of healthcare when community health centers (CHCs) shift from fee-for-service to global per-member per-month (PMPM) capitation payments. This study expands on our qualitative evaluation, which collected invaluable baseline data from Phase 1 of the APM demonstration project.

The eCHANGE study will compare key measures of service utilization, quality, and cost of healthcare before and after APM implementation in the 8 Phase 1 CHC clinics to understand the impact of APM. To isolate the APM impact from other concurrent primary care delivery transformation initiatives, we will match each Phase 1 intervention site with a non-intervention (or ‘control’) site that is similar on a number of factors – such as patient population, geography, and clinic size – but has not implemented APM.

Findings from eCHANGE will have national relevance and will help inform the efforts of other states who are interested in implementing APMs. Specifically, insight gained through this study has the potential to greatly improve primary care delivery and patient health by:

  • Filling a critical knowledge gap: understanding whether APMs can improve patient health at reduced cost is imperative as traditional fee-for-service reimbursement models are not achieving improvements;
  • Measuring the real-time effects of health policy changes on care delivery in CHCs;
  • Evaluating the APM ‘natural experiment’ to assess service utilization, quality of care, and cost of healthcare;
  • Engaging CHCs in a study that will inform ongoing / future policy and practice changes; and
  • Informing the potential dissemination of APM methods to additional CHCs and/or other primary care settings.
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Link Round Up

Today’s link round up covers national initiatives focused on increasing value over volume and data sharing as a key player in alternative payment methods.

The Health Care Payment Learning and Action Network, made up of the Department of Health and Human Services and partners in the private, public and non-profit sectors, is working towards a transition to value based payment. This collaboration between payers, providers, consumers and other key stakeholders will align efforts and lay the groundwork for payment reform. The network’s work is linked to increasing the percentage of Medicare fee-for-service payments linked to quality. Read more in this press release and this article from Health IT Outcomes.

An article over on Health Leaders Media discussed the need for more “accurate, actionable and timely information” for physicians. While physicians are interested in alternative payment models, they’re also overwhelmed by the required metrics and reporting required by payers. This is an area that’s been heavily discussed within the APM pilot clinics here in Oregon.  The article highlights a study by RAND researchers that found practices are collaborating with others to support the upfront investment required by alternative payment models, but challenges arise when payment models conflict with one another.

However, at the same time alternative payment models have prompted more health data sharing,  as the New York Times published: “the economic incentives for data-sharing, some medical experts say, are beginning to fall into place.” The article discusses sharing data with patients, in particular, to improve health outcomes.