Medicare QPP

Physicians Advocacy Institute

Advanced APM Pathway

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Advanced APM Resource Navigation Tool

This interactive tool will help you navigate what resources and support organizations are available and can provide additional information for those already participating in an Advanced APM and those interested in participating in an Advanced APM.

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Advanced APM Overview

Advanced APMs are one of two pathways physicians can choose under the Quality Payment Program (QPP. Under the Advanced APM Pathway, physicians may be eligible to receive a 5% incentive payment. This resource provides an overview of the relevant QPP rules for Advanced APM participation thresholds and requirements.

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Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model

The ACO REACH model is CMMI’s redesigned Global and Professional Direct Contract Model (GPDC) in response to Administration priorities. ACO REACH seeks to add organizations to CMS risk-sharing arrangements that have not been eligible for the Medicare Shared Savings Program and/or the Next Generation ACO (NGACO) model. This resource focuses on the variables and rules impacting performance under ACO REACH.

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Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) Models

The Centers for Medicare and Medicaid Services (CMS) established the MSSP under the authority of the Affordable Care Act (ACA). This resource focuses on the variables and rules impacting performance under MSSP ACO BASIC Track Levels A-E as well as the ENHANCED Track.

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Primary Care First (PCF) Model

PCF is based on the principles underlying the Comprehensive Primary Care Plus (CPC+) model design: prioritizing the physician-patient relationship; enhancing care for patients with complex chronic needs, and focusing financial incentives on improved health outcomes. This resource focuses on understanding the variables and rules impacting performance under the Primary Care First (PCF) model.

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Enhancing Oncology Model (EOM) Overview

EOM is a 5-year voluntary model that aims to improve quality and reduce costs through payment incentives and required participant redesign activities. CMS designed EOM to test how to improve health care physicians’ ability to deliver care centered around patients, consider patients’ unique needs, and deliver cancer care in a way that will generate the best possible patient outcomes.

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MIPS APM Overview

This resource provides an overview of MIPS APMs, which are a hybrid between the MIPS pathway and the Advanced APM pathway and have different reporting requirements and scoring than if physicians were participating in exclusively one pathway.

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Side-by-Side Comparison of ACOs

This resource provides a side-by-side comparison of the requirements, risk arrangements, and other APM specifications for the Medicare Shared Savings Program (MSSP) ACO BASIC Track Levels A-E as well as the ENHANCED Track.

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APM Building Blocks for Success

This resource highlights the types of variables and rules to be attuned to for specific Advanced APMs. Specifically, this resource will provide an overview of the interactions between core care management techniques, data insights, and what it means to “take risk.”

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MIPS APM Scoring Overview

This resource details the scoring standard used for MIPS APMs, a hybrid between the MIPS pathway and the Advanced Alternative Payment Model (APM) pathway.

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