Table 5. Summary of 17 APM Implementation Findings Based on Outcomes Examined.
| APM implementation | LAN category | Outcome category | Source | |
|---|---|---|---|---|
| Statistically significant evidence for outcome or significant difference for at least 1 measured outcome | Nonstatistically significant difference, minimal significant difference, or no statistical test provided | |||
| Sustaining Healthcare Across Integrated Primary Care Efforts Program | 2A | Processes of care | Ross et al,39 2019 | NA |
| Spending | NA | Ross et al,39 2019 | ||
| Adolescent Community Reinforcement Approach | 2C | Processes of care | Garner et al,40 2011; Garner et al,41 2012; Lee et al,43 2012; Garner et al,42 2018 | NA |
| Clinical outcomes | Garner et al,42 2018 | Garner et al,41 2012 | ||
| Spending | Garner et al,42 2018 | NA | ||
| Spectrum Addiction Services | 2C | Processes of care | Shepard et al,44 2006a | NA |
| Outpatient psychosocial counseling treatment center in Maryland | 2C | Processes of care | Vandrey et al,45 2011a | NA |
| Utilization | Vandrey et al,45 2011a | NA | ||
| Patient dumping, gaming, or adverse selection | NA | Vandrey et al,45 2011a | ||
| Washington State Mental Health Integration Program | 2C | Processes of care | Bao et al,47 2017; Unutzer et al,46 2012 | NA |
| Clinical outcomes | Unützer et al,46 2012 | NA | ||
| Patient dumping, gaming, or adverse selection | Unützer et al,46 2012 | NA | ||
| Connecticut’s Behavioral Health Partnership | 2C | Processes of care | Schmutte et al,48 2019a | NA |
| Medicare Shared Savings Program Accountable Care Organizationsb | 3A | Processes of care | Busch et al,36 2016; Busch et al,37 2017 | NA |
| Clinical outcomes | NA | Busch et al,36 2016 | ||
| Spending | NA | Busch et al,36 2016 | ||
| Utilization | NA | Busch et al,36 2016 | ||
| Patient dumping, gaming, or adverse selection | Busch et al,36 2016 | NA | ||
| Maine Medicaid Accountable Communities Initiativec | 3A | Processes of care | NA | Beil et al,38 2019 |
| Spending | NA | Beil et al,38 2019 | ||
| Utilization | NA | Beil et al,38 2019 | ||
| Vermont Medicaid Shared Savings Programc | 3A | Processes of care | NA | Beil et al,38 2019 |
| Spending | Beil et al,38 2019 | NA | ||
| Utilization | Beil et al,38 2019 | NA | ||
| Medicare Pioneer Accountable Care Organizationsb | 3B | Processes of care | Busch et al,37 2017 | Busch et al,36 2016 |
| Clinical outcomes | NA | Busch et al,36 2016 | ||
| Spending | Busch et al,36 2016 | NA | ||
| Utilization | NA | Busch et al,36 2016 | ||
| Patient dumping, gaming, or adverse selection | Busch et al,36 2016 | NA | ||
| Minnesota Integrated Health Partnerships Programc | 3B | Processes of care | Beil et al,38 2019 | NA |
| Spending | NA | Beil et al,38 2019 | ||
| Utilization | Beil et al,38 2019 | NA | ||
| Delaware Division of Substance Abuse and Mental Health–Outpatient Services APM | 4A | Processes of care | Stewart et al,49 2013 | McLellan et al,50 2008a |
| Utilization | NA | McLellan et al,50 2008a | ||
| Patient dumping, gaming, of adverse selection | NA | McLellan et al,50 2008a; Stewart et al,49 2013 | ||
| Delaware Division of Substance Abuse and Mental Health–Detoxification Care Transition APM | 4A | Utilization | NA | Haley et al,51 2011a |
| Patient dumping, gaming, or adverse selection | Haley et al,51 2011a | NA | ||
| Maine Addiction Treatment System, phase 1 of performance-based contracting | 4A | Clinical outcomes | Commons et al,52 1997a | NA |
| Utilization | Commons et al,52 1997a | NA | ||
| Patient dumping, gaming, or adverse selection | Shen,56 2003; Lu et al54 2003; Lu,53 1999a; Lu and Ma,55 2006 | NA | ||
| Maine Addiction Treatment System, phase 2 of performance-based contracting | 4A | Processes of care | NA | Brucker and Stewart,57 2011a; Stewart et al,58 2018 |
| Utilization | NA | Brucker and Stewart,57 2011a | ||
| Patient dumping, gaming, or adverse selection | NA | Stewart et al,58 2018 | ||
| BCBSMA Alternative Quality Contract | 4B | Processes of care | Barry et al,59 2015; Stuart et al,60 2017 | NA |
| Spending | Barry et al,59 2015 | Stuart et al,60 2017; Donohue et al,61 2018 | ||
| Utilization | Barry et al,59 2015; Stuart et al,60 2017 | Donohue et al,61 2018 | ||
| Oregon Coordinated Care Organizations | 4B | Processes of care | NA | Rieckmann et al,62 2018c |
Abbreviations: APM, alternative payment model; BCBSMA, Blue Cross/Blue Shield of Massachusetts; LAN, Learning and Action Network; NA, not applicable.
a
Publication had a quality rating of 3B or 3C according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence modified for this investigation (Table 2).
b
Busch et al36 and Busch et al37 were counted twice (in LAN 3A and 3B) because both study publications describe APMs in the 2 categories.
c
Beil et al38 was counted 3 times (in LAN 3A and 3B) because it describes and analyzes 3 different APM implementations.