Some Lessons Learned Around Alternative Payment Models

The more successful programs include those with a path to risk. With upside risk, providers only gain if they exceed expectations on quality, cost or other metrics, says Corinne Lewis, program officer for delivery system reform at the Commonwealth Fund. Providers can lose revenue if they fail to meet goals with downside risk. “Evidence suggests that models using both have better outcomes,” Lewis observes, because the risk of losing revenue can be a strong influence and “more motivation than a carrot.” In Lewis’ opinion, when designing a program, downside risk should be voluntary because it can prevent a provider from joining the program. Payers can create on-ramps to increase participation in these programs, easing providers in and providing the right incentives for meaningful change, Lewis says.