Principles for Negotiating Alternative Payment Methodologies

Module Description

Healthcare is encountering a seismic shift from volume to value. Alternative Payment Methodologies (APMs) describe the way that providers will be paid for value. There is a spectrum of APMs that require various levels of clinical and administrative preparation.  Providers will need to work with payers to negotiate APMs and ensure that the degree of financial accountability is commensurate with clinical and administrative performance. This module describes APMs and how providers can work with payers to move along the APM continuum.

Intended Audience

This course is designed for physicians as well as nurse practitioners, physician assistants, and allied health professionals who are working toward population health management, especially in safety-net settings.

Duration and Fee

Estimated Time to Complete: 1 hour

Registration Fee: $20

CME Credits

This Enduring Material activity, Population Health in the Safety Net, has been reviewed and is acceptable for up to 12.00 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 10/01/2018. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty

A pioneer in the accountable care organization movement, Dr. Arthur Jones has 27 years of “boots-on-the-ground” experience as the founding physician and CEO of Lawndale Christian Health Center — a large urban community health center on Chicago’s west side. While at HMA, Dr. Jones has worked with numerous providers and payers to develop payment strategies that work to transform healthcare and bring value to the delivery system.

Dr. Arthur Jones discloses that he is an employee of Health Management Associates, a national research and consulting firm providing technical assistance to a diverse group of healthcare clients.

Learning Objectives

At the completion of the course, attendees will be able to:

  • Identify the limitations of the fee-for-service payment methodology
  • Compare and contrast the spectrum of alternative payment methodologies
  • Describe a systematic approach to analyzing various APM offers
  • Describe a strategy for the negotiating APMs with health plans