Great discussion by @medicarepayment right now. Opening comments by @Michael_Chernew: "CMS has a portfolio problem" that is holding back its evaluation and management of advanced alternative payment models.

@Michael_Chernew: CMS is currently operating 40 alternative payment models. In order for @CMSinnovates to evaluate properly the models, there needs to be a "coherent framework" for understanding model overlap and interaction.

@AmolNavathe: We focus principally on cost savings and quality of care. This is consistent with @CMSinnovates's statutory mandate. But moving forward, there should be a strong relative emphasis on how (and whether) alternative payment models "stimulate practice transformation."

@AmolNavathe: @medicarepayment can support @CMSinnovates by articulating a framework for how the models work together (population-based payment, episode-based payment, and PCMH). This will lead to a rationalization of the "potpourri" of APMs.

@AmolNavathe: We should refine our understanding of selection and how providers decide to enter a particular model. Moreover, @medicarepayment should encourage @CMSinnovates to use an evaluation framework that includes "spillover" analyses and a longer-term horizon.

@gelb_dana: Models need to give providers certainty. Mid-model tweaks or changes to the financial incentives will not give providers the certainty in forecasting the choice between participating or not participating in a particular model.

@gelb_dana: @medicarepayment should support a standardization of the method of evaluation of APMs. And there should not be mid-model changes to the evaluation of a particular APM.