PTAC Resources

Identifying a Pathway Toward Maximizing Participation in Population-Based Total Cost of Care (PB-TCOC) Models
(September 2024)

• Environmental Scan: Identifying a Pathway Toward Maximizing Participation in PB-TCOC Models

Addressing the Needs of Patients with Complex Chronic Conditions or Serious Illnesses in Population-Based Total Cost of Care (PB-TCOC) Models
(June 2024)

• Environmental Scan: Addressing the Needs of Patients with Complex Chronic Conditions or Serious Illnesses in PB-TCOC Models

Developing and Implementing Performance Measures for PB-TCOC Models
(March 2024)

• Environmental Scan: Developing & Implementing Performance Measures for PB-TCOC Models
• Current Performance Measures Overview Report
• Performance Measures Data

Encouraging Rural Participation in PB-TCOC Models
(September 2023)

• Report to the Secretary: Encouraging Rural Participation in PB-TCOC Models
• Environmental Scan: Encouraging Rural Participation in PB-TCOC Models

Care Transitions in Population-Based Models
(June 2023)

• Report to the Secretary: Improving Management of Care Transitions in PB-TCOC Models
• Environmental Scan: Improving Management of Care Transitions in Population-Based Models
• Impact of Transitional Care Management Services on Utilization, Health Outcomes, and Cost Among Medicare Beneficiaries, 2018-2019

Specialty Integration in Population-Based Models
(March 2023)

• Report to the Secretary: Improving Care Delivery and Specialty Integration in PB-TCOC Models
• Environmental Scan: Improving Care Delivery & Integrating Specialty Care in Population-Based Models

Population-Based Total Cost of Care (TCOC) Models
(March, June, and September 2022)

• Report to the Secretary: Optimizing PB-TCOC Models in the Context of APMs and PFPMs
• Environmental Scan: PB-TCOC Models in the Context of APMs and PFPMs
• Supplement to the Environmental Scan on Population-Based Total Cost of Care Models
• Second Supplement to the Environmental Scan Related to the Development of Population-Based Total Cost of Care Models

Social Determinants of Health (SDOH) and Equity and Alternative Payment Models
(September 2021)

• Report to the Secretary: Addressing SDOH and Equity in APMs and PFPMs
• SDOH and Equity Overview Document
• SDOH and Equity PTAC Proposal and CMMI Model Analysis

Care Coordination and Alternative Payment Models
(June 2021)

• Report to the Secretary: The Role of Care Coordination in Optimizing Health Care Delivery and Value-Based Care Transformation within APMs and PFPMs
• Environmental Scan: Care Coordination in the Context of APMs and PFPMs
• Environmental Scan on Care Coordination Supplement
  • Innovative Approaches
  • Analysis of 2019 Medicare Fee-for-Service (FFS) Claims for Chronic Care Management (CCM) and Transitional Care Management (TCM) Services

Telehealth and Alternative Payment Models
(September 2020)

• Report to the Secretary: The Role of Telehealth in Optimizing Health Care Delivery and Value-Based Transformation within APM’s and PFPMs
• Environmental Scan: Telehealth in the Context of APMs and PFPMs
• Telehealth Environmental Scan Supplement
• Telehealth September 2020 Summary Report

Charting Future Directions Paper

The Charting Future Directions paper is an ASPE staff paper that offers historical context about PTAC, current opportunities, and future directions for the Committee.

Common Alternative Payment Model (APM) Approaches: Reference Guide

The Common APM Approaches Reference Guide summarizes some major types of payment methodologies that are typically used in APMs.

Review of Proposed Models

Two reports and a set of slides that review the proposed models deliberated and voted on by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) as of December 2019 are available below:

• Slides of Proposed Models Voted on by PTAC
• Report on Proposed Models Voted on by PTAC
• Report on PTAC Voting Patterns and Comments on Proposals

Data

• Federal Public Data: A Guide for Navigating Publicly Available Files for Those Developing Physician-Focused Payment Models
  This document highlights publicly available data sources that could be used in the development of Physician-Focused Payment Model (PFPM) proposals.
• Illustrative Data on Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries with Certain Medical Conditions (PDF and Excel)
  • Table 1A: Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries Newly Diagnosed with Congestive Heart Failure, Calendar Year 2014 - PDF
  • Table 1B: Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries Ever Diagnosed with Congestive Health Failure, Calendar Year 2015 - PDF
  • Table 1C: Medicare Utilization and Reimbursement in the One-Year Period Following Diagnosis Fee-for-Service Beneficiaries with a 2014 Diagnosis of Congestive Heart Failure - PDF
  • Table 2A: Average Total All-cause Medicare Fee-for-Service Spending for Selected Chronic Conditions, 2015 - PDF
  • Table 2B: Average All-cause Part A Medicare Fee-for-Service Spending for Selected Chronic Conditions, 2015 (Based on the CMS 5% Limited Data Set) - PDF
  • Table 2C: Average All-cause Part B Medicare Fee-for-Service Spending for Selected Chronic Conditions, 2015 (Based on the CMS 5% Limited Data Set) - PDF
  • Appendix A: CHMS Chronic Conditions Data Warehouse (CCW)- CCW Condition Algorithms (rev. 7/2016) - PDF
  • Excel Workbook - All Tables, Illustrative Data on Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries with Certain Medical Conditions

Toolkits, Examples of Payment Models, and Additional Resources

• Alternative Payment Model Design Toolkit by Center for Medicare & Medicaid Innovation
• Link to the Quality Payment Program (QPP) Website
  This website includes more information on the Quality Payment Program (QPP) including a description of the program, information on participation, a detailed implementation timeline, and a description of how QPP will change Medicare payments.
• Examples of Health Care Payment Models Being Used in the Public and Private Sectors by Social & Scientific Systems, Inc.
• Information from the Specialty Payment Models Opportunities and Design Initiative by MITRE
  • RAND’s Specialty Payment Model Opportunities and Assessment Oncology Simulation Report
    This report describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS).
  • RAND’s Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report
    This report describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS).

Archived Webinars (2016-2017)

Please note that information in these webinars may be outdated. For the most current information, please review the Submit a Proposal page.

• Webinars hosted by the Physician-Focused Payment Model Technical Advisory Committee
  • “How to Submit a Proposal to PTAC: Clarifications and Tips for Submitters” hosted by PTAC Members Harold Miller and Robert Berenson, MD on February 27, 2017 from 2:00-3:00 pm ET.
    The slides for "How to Submit a Proposal to PTAC: Clarifications and Tips for Submitters” webinar are available.
  • "How to Submit a Proposal to the Physician-Focused Payment Model Technical Advisory Committee (PTAC)" hosted by PTAC Members Harold Miller and Dr. Kavita Patel
    The slides for "How to Submit a Proposal to the Physician-Focused Payment Model Technical Advisory Committee (PTAC)" webinar are available.
  • "Overview of the Physician-Focused Payment Model Technical Advisory Committee (PTAC)" hosted by PTAC Chair Dr. Jeffrey Bailet, Vice Chair Elizabeth Mitchell, and Member Robert Berenson, MD.
    The slides for "Overview of the Physician-Focused Payment Model Technical Advisory Committee (PTAC)" webinar are available.

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