Table 1.

Design elements for the implementation of an alternative payment model.

	Design Elements
Specify bundle and select provider [s]: characteristics of a contract specified by a health insurer and one contracting entity or multiple healthcare providers	How to delineate the population?
	Definition of the patient population?
	Small or heterogeneous patient populations?
	How to attribute patients to a provider group?
	Which providers are included?
	Mandatory or voluntary bundled payment?
	Who is the main contractor?
	Are the group members employed or subcontracted?
	What care services are included in the bundle?
	[Re]Allocation of care delivery among providers?
	Prospective or retrospective payment strategy?
Negotiate and sign contract: negotiate about price, volume, weight of case-mix method, quality measurement and quality incentive structure, distribution of savings/losses, and risk-mitigating measures for providers	Is the payment real or virtual?
	How to set a payment/target? (Calculate the average annualizing expenditures, Weight the expenditures, and Cap expenditures, evaluate expenditures against a benchmark, Trending factor, Risk adjustment)
	Allocation of possible savings?
	One-sided or two-sided risk?
	What is the risk-sharing rate?
	Is there a maximum saving rate according to the costs?
	Is risk adjustment applied?
	Which risk adjustors are used?
	What is the contract duration?
	What care to carve out?
	Are shared savings/losses conditional on quality?
	Add-on for quality?
	Which quality indicators to use?
	What measurement level [individual/group]?
	Rewards and/or penalties?
	Maximum payment size relative to total payment?
	Absolute, relative and/or improvement targets?
	How often to pay for performance?