Over the past several years, participation in Medicare's ACOs and bundled payment initiatives has spread across the US. But a familiar pattern has emerged. New payment models tend to shadow markets where Medicare Advantage programs have seen some success. The reason: Medicare Advantage essentially mirrors a capitated payment model, which rewards high quality and efficient care-the same tenets that drive alternative payment models.
The government throws its weight around. CMS aims to link 90% of Medicare payments to quality programs, and 50% to alternative payment models.
Market factors - such as competition and employer demand - influence the speed toward alternative payment models.
Before transformation comes self-examination. The first step away from fee-for-service is a clear understanding of an organization's strengths, weaknesses and mission.