Alternative Payment Models and Direct Contracting Overview

This document is a report that discusses alternative payment models (APMs) and the recent developments in direct contracting as part of the Biden administration's focus on value-based care. It outlines the modified end-stage renal disease (ESRD) payment model introduced by the Centers for Medicare & Medicaid Services (CMS), which aims to address health equity by incentivizing dialysis providers to reduce disparities in care among disadvantaged populations. The report also details the transition from the Next Generation ACO Model to the Global and Professional Direct Contracting Model, emphasizing the new opportunities for risk-sharing arrangements between private health care providers and traditional Medicare. Furthermore, it presents insights from industry experts on the operational aspects and potential benefits of these models, including the importance of managing pre- and post-acute care to improve patient outcomes while controlling costs. The report highlights the ongoing evolution of APMs and their implications for the future of health care delivery.