Medicaid Health Plan Requirements for Provider Alternative Payments: The 2020 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 only pay-for-volume or fee-for-service (FFS) payment models. Within APMs there are two main categories of payments:

Pay-for-performance (P4P) – A payment system that, in addition to existing FFS payments, offers financial rewards or penalties for meeting or failing to meet specific performance measures, such as quality, cost, and other benchmarks. Generally, under P4P models, a single metric or set of individual metrics are taken into account. Examples of P4P models . . .