Creating an Enabling Environment for Specialty Alternative Payment Models: A Potential Role for Philanthropy

Abstract

In the ongoing shift from volume to value in US health care, primary care value-based alternative payment models (APMs), such as accountable care orga­nizations, have dominated the landscape when compared to specialty care APMs. Interviews with hundreds of payers and clinicians across various specialties signal that there are ongoing challenges with investing in, designing, and scal­ing specialty APMs, especially for populations covered by commercial insurers. Several critical gaps complicate specialty APMs’ business case for these stake­holders, including uncertain returns on investment, lack of understanding around optimal outcome and performance measures, and data silos. Given the per­sistence of these challenges, which require collaboration between payers and providers on research, transparency, and technical assistance to address, phil­anthropic support may be a helpful and overlooked resource to support a better enabling environment for specialty APMs.