Percentage of Fee for Service payments linked to quality and value:
Categories of payment models are defined in Alternative Payment Model Framework and Progress Tracking (APM
FPT) Work Group – Alternative Payment Model (APM) Framework Final White Paper.
Plan Year for examples of payment models within each category.
To calculate the percentage of payments for Fee for Service payments linked to quality and value, and/or Alternative
Payment Models tied to quality and value, issuers should use the calculation methodologies defined in the Measuring
Progress: Adoption of Alternative Payment Models in Commercial, Medicare Advantage, and State Medicaid Programs
instructions to calculate the percentage of payments for these two payment model categories.
QIS Implementation Plan and Progress Report Form
Expiration Date: 10/31/2018
15. Current Payment Model(s) Description
Select the category(ies)
of payment models that are used by the issuer across its Exchange
product line. If “Fee for
Service – Linked to Quality or Value” AND/OR “Alternative Payment Models
Built upon Fee for Service Architecture” is checked, provide the percentage of payments tied to
quality or value.
Payment Model Description
Fee for Service – No Link to
Quality and Value
Payments are based on volume of services
and not linked to quality or efficiency.
Fee for Service – Linked to Quality
At least a portion of payments vary based on
the quality or efficiency of health care delivery.
Alternative Payment Models Built
on Fee for Service Architecture
Some payment is linked to the effective
management of a segment of the population
or an episode of care. Payments still triggered
by delivery of services, but opportunities for
shared savings or two-sided risk.
Payment is not directly triggered by service
delivery so payment is not linked to volume.
Clinicians and organizations are paid and
responsible for the care of a beneficiary for a
long period (e.g., more than one year).
Percentage of payments tied to quality and
value through alternative payment models:
Provide percentage of payments:
https://hcp-lan.org/workproducts/apm-whitepaper.pdf. See the QIS Technical Guidance and User Guide for the 2019
(APM Measurement Effort) Final Paper. https://hcp
-lan.org/groups/apm-fpt/apm-report/. See Table 1 (p. 7-10) for
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estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop
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