APMs Overview

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.

What models are Advanced APMs?

In 2017, the following models are Advanced APMs:

We predict that approximately 100% of eligible clinicians in the following Advanced APMs will be Qualifying APM Participants (QP) in performance year 2017 - meaning we predict that they will be eligible to receive a 5% APM Incentive Payment in 2019. Our prediction is based on claims with dates of service between 1/1/16 and 8/31/16 that were processed between 1/1/16 and 11/30/16.

The list of Advanced APMs included is as follows:

  • Next Generation ACO Model
  • Comprehensive ESRD Care (CEC) Model - Two-Sided Risk
  • Comprehensive Primary Care Plus (CPC+) Model
  • CPC+ only: Eligible clinicians were assessed only as part of their CPC+ Practice group.
  • CPC+ and Medicare Shared Savings Program (Shared Savings Program) Tracks 2 or 3: Eligible clinicians were assessed only as part of their Shared Savings Program Track 2 or 3 ACO.
  • Medicare Shared Savings Program - Track 2
  • Medicare Shared Savings Program - Track 3

Although the Oncology Care Model (OCM)—Two-Sided Risk Arrangement and the Comprehensive Care for Joint Replacement Model (CJR)—CEHRT Track are Advanced APMs for performance year 2017, we did not make predictions for these models.

These results do not reflect all Advanced APMs for performance year 2017. We’ll release the initial QP determinations later this year.

Disclaimer: These results are based on historical data. The Methodology Fact Sheet can help you understand how we determined the predictive QP Status.

How do I join an Advanced APM?

  1. Learn about specific Advanced APMs and how to apply.
  2. Apply to an Advanced APM that fits your practice and is currently accepting applications.
  3. This website will be updated as new information is available.

What happens if I am in an Advanced APM?

Once you're in an Advanced APM, you'll earn the 5% incentive payment in 2019 for Advanced APM participation in 2017 if:

  • You receive 25% of your Medicare Part B payments through an Advanced APM or
  • See 20% of your Medicare patients through an Advanced APM

You'll need to send in the quality data required by your Advanced APM. Your model's website will tell you how to send in your Advanced APM's quality data.

If you leave the Advanced APM during 2017, you should make sure you've seen enough patients or received enough payments through an Advanced APM to qualify for the 5% bonus. If you haven't met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.