Medicaid Health Plan Requirements For Provider Alternative Payment Models: The 2019 State-By-State Update

Alternative payment methodologies (APMs) is an umbrella term used to describe payment models that focus on quality, cost of care, or both, rather than utilizing pay-for-volume or fee-for-service (FFS) payment models. Value-based reimbursement (VBR) is a subset of APMs that focuses on both quality and cost of care.

The move to APMs is precipitated by a number of factors, including a higher proportion of the population insured under the Patient Protection and Affordable Care Act (PPACA), a disproportionate population using the majority of health care resources, integrated health management, an increased need for transparency, and . . .