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Alternative Payment Models (APMS)

Alternative Payment Models (APMs) and Accountable Care Organizations (ACOs)

Accountable Care Organizations (ACOs) and other alternative payment models (APMs) continue to grow as health system reform continues under Medicare Access and CHIP Reauthorization Act (MACRA) as well as in the private sector. While participation will vary geographically and across organizations, pathologists can help ACOs and some of the other models achieve their goals through focusing on care coordination, quality improvement, and population management.

With the accelerated implementation of new payment models under MACRA, coupled with expanded activity in the private sector, it is imperative to build awareness prepare for implementation of new payment models. These models include as ACOs, bundled payments, and other APMs. Additionally, our efforts are focused to favorably influence federal and state policies on these payment models for pathologists.

Ensuring Pathologists' Role in Coordinated Care and APMs

The CAP and its Council on Government and Professional Affairs developed and drove legislation requiring ACOs to establish Clinical Laboratory Advisory Boards led by pathologists. The boards rely on the pathologist medical director to help the ACO ensure appropriate testing. They help identify and eliminate unnecessary pathology and laboratory testing. The boards also ensure that patients enrolled in the ACO receive all medically necessary tests. CLABs have demonstrated compelling medical value, implemented at nationally esteemed health care centers, and have served as a model for federal policymakers.

Learn how the CAP supports state enactment of model legislation to require accountable care organizations to establish clinical laboratory advisory boards.

Pathologists Toolkit for Success in a Value-Based Care Market

Adapt to the changing health care payment models with our business management toolkits to help your practice transition and flourish in this new environment.

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