Joining an APM can be complex from an organizational standpoint and includes many considerations and requires prioritizing strategic decisions at an organizational level. The Organizational Readiness category will walk through a series of key questions and considerations on approaches to risk strategies, external partnerships, workforce and other key elements. Review the following questions and responses to determine your organizational preparedness.
Does your practice have insight into governance decisions related to APM participation?
|If yes||Your practice is appropriately informed of the decision to participate in APMs, or participates in the decision making to engage in APMs.|
|If no||Your practice may not be part of the decision-making process or up-to-date on the risk strategy direction or decision to participate in APMs. Consider the impact prior to APM participation|
|If unsure||Ensure your practice has a clear understanding of governance decisions prior to making a commitment to participate in an APM.|
Value-Based Payment Strategy
Does your practice have a strategy for value-based payments?
|If yes||This APM meets the specific elements within your practice’s risk-based strategy.|
|If no||Pursuing this APM absent a risk-based strategy that defines the risk and benefits to perform effectively could potentially result in poor financial or clinical performance. Consider the impact prior to APM participation.|
|If unsure||Determine if your practice has a strategy toward value-based payments that will align priorities and provide guidance toward specific APMs prior to participation.|
Does your practice have physician champions that support a value-based strategy, create awareness and provide education about APMs?
|If yes||Your practice has identified physician champions and has the support to stay current on new payment models, regulations and emerging payer requirements.|
|If no||Your practice needs to identify physician champions and potentially provide them educational opportunities to understand the complex and changing facets of value-based payment arrangements prior to APM participation.|
|If unsure||Seek clarity on the role physician champions are engaged with in your practice setting. Leverage ACC educational materials and events to stay current on value-based payment topics to understand practice impacts prior to APM participation.|
Has your practice identified adequate clinical competencies and workflow requirements to be successful within an APM?
|If yes||Your practice is prepared for the administrative, clinical and operational demands of this APM.|
|If no||Your practice may not be prepared for the administrative, clinical and operational demands of this APM and should identify clinical competencies and workflow requirements necessary for success.|
|If unsure||Perform a gap analysis on the personnel and skill set this APM needs compared to your practice’s current resource capabilities prior to APM participation.|
Does your practice have relationships with providers along the continuum of care?
|If yes||Your practice has the necessary relationships in place with acute and post-acute care providers, primary care providers (PCP), and other specialists to be successful in an APM environment.|
|If no||Your practice needs to develop relationships with acute and post-acute care providers, PCPs or other specialists. Consider potential solutions prior to APM participation.|
|If unsure||Determine the relationship gaps that limit your practice from optimizing care coordination and transitions of care prior to APM participation.|
Has your practice evaluated and understood the contractual obligations of an APM?
|If yes||Your practice should be in a good position to comply with obligations critical to recognizing incentive payments and mitigating downside risk for your practice.|
|If no||Your practice’s lack of knowledge on contractual obligations increases the risk for potential losses. Consider potential solutions prior to APM participation.|
|If unsure||Identify specific contractual obligations and develop a mitigation strategy for each obligation to determine whether an APM is viable to pursue.|
Review the key contractual obligations through the American Medical Association's Evaluating Pay-For-Performance Contracts document.
Can your practice identify opportunities for strategic decision making that can lead to actionable change and ongoing performance monitoring?
|If yes||Prioritize operational changes that have the highest impact and put actionable plans in place to achieve those opportunities under an APM.|
|If no||If your practice is not able to identify and prioritize opportunities, performance improvement could be limited. Consider potential solutions prior to APM participation.|
|If unsure||Assess whether your practice can identify opportunities, drive improvements and monitor performance prior to APM participation.|