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Payment Models

How are providers compensated for medical services and rewarded or penalized for performance?

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Fee-for-service

Does reimbursing providers on utilization encourage high quality, low cost care for patients?

Policy Definition: As outlined in the Health Care Learning & Action Network Advancement Payment Model Framework, fee-for-service is a payment model structured based on volume of services and not linked to quality of care or efficiency. source

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Fee-for-Service — Link to Quality and Value

Does reimbursing providers by incentivizing quality and performance encourage high quality, low cost care for patients?

Policy Definition: As outlined in the Health Care Learning & Action Network Advancement Payment Model Framework, fee-for-service with linkage to quality and value bases a portion of payments based on the quality or efficiency of healthcare delivery. source

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Alternative Payment Models

Does reimbursing providers by incentivizing and penalizing based on quality and performance encourage high quality, low cost care for patients?

Policy Definition: As outlined in the Health Care Learning & Action Network Advancement Payment Model Framework, Alternative Payment Models (APM) are payments that are linked to the effective management of a segment of the population or an episode of care. These payments are trigged by delivery services but have opportunities for shared savings or downside risk. source

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Population Based Payments

Does reimbursing providers a global budget to manage care rather than paying for services encourage high quality, low cost care for patients?

Policy Definition: As outlined in the Health Care Learning & Action Network Advancement Payment Model Framework, population based payments are payments that are not triggered by service delivery, and therefore, not linked to volume. Providers are paid and responsible for the care of a beneficiary for an extended period of time. source

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