Why Training & Technical Assistance is Critical to the Success of Alternative Payment Models

Medicare’s Alternative Payment Models (APMs) have resulted in gross savings of $0.7 to $2.9 billion dollars per year. These models reward health care providers for delivering high-quality, cost-efficient care by reforming payment structures and thus enhancing patient access to advanced primary care services and improved health care delivery.

For successful participation in APMs, primary care providers must:     

• understand beneficiary attribution and payment methodology,
• monitor and utilize performance data effectively, and
• meet care delivery and quality measurement reporting requirements. 

Navigating these elements requires nuanced training & technical assistance (TTA) and model support to track data, uphold quality, and enhance communication. For the past eight years, RTI International has supported the Center for Medicare & Medicaid Innovation (also known as the Centers for Medicare & Medicaid Services (CMS) Innovation Center) in implementing APMs in primary care including the Comprehensive Primary Care Plus (CPC+), Primary Care First (PCF), and Making Care Primary (MCP) models.

RTI provided support and TTA to more than 6,100 primary care practices participating in the alternative payment models, helping them understand and meet model requirements through the four key components below. These components have been foundational to ensuring the success of model implementation and can be leveraged for future models to solve for common challenges with providers. 

Key Components of Medicare APM Support and TTA

1. Dedicated Help Desk

A help desk with high customer service standards is critical for implementing a rigorous Quality Assurance (QA) and Quality Control (QC) process to ensure smooth model operations. Help desk inquiry analyses can also be used to identify challenges and refine policies for improvement.

Key help desk features include:

• Model-Specific Help Desk: A dedicated help desk for each model effectively tracks and addresses participant inquiries, ensuring they remain well-informed about model policies and compliance requirements.
• Tiered Response Structure: A tiered and coordinated approach helps manage inquiries efficiently, with Tier 1 staff handling ticket logistics, Tier 2 addressing routine inquiries, Tier 3 subject matter experts (SMEs) handling more specialized or complex questions, and policy issues being escalated to CMS as necessary. RTI developed a detailed protocol for efficient tracking and escalating issues to designated CMS staff to ensure that even the most complex questions are addressed promptly.
• Quality Assurance and Control: Robust QA/QC procedures maintain strict customer service standards including effective and customer-friendly communications, accuracy and timeliness of responses, and closing procedures that provide ample time for the customer to acknowledge resolution. Help desk oversight and on-going, unbiased evaluations of resolved help desk tickets allow for continuous quality improvement.
• Tracking and Reporting: Monthly quantitative and qualitative reports of help desk inquiries, shared with the CMS Model Team, identify participant knowledge gaps and challenges, guiding the development of educational resources and possible modifications to model policies to improve participant outcomes. This analysis also helps evaluate participants' engagement over the model's duration. Our experience on the primary care models found that in some models, the volume of questions decreased over time and shifted from procedural issues to more complex discussions on payments, care delivery transformation, and quality improvement.

2. Communication and Outreach

A comprehensive communication and outreach strategy ensures that alternative payment model participants remain well-informed, engaged, and supported throughout their participation. The strategy should include regular communications and targeted outreach to address emerging issues, ensure model compliance, and convey critical model updates and deadlines.     

 RTI found that key components of a successful communication strategy include:

• Model Newsletters: Bi-weekly email newsletters that consolidate essential messages, reporting deadlines, and best health care delivery practices provide a structured communication rhythm that keeps participants informed without information overload. Each newsletter issue can also link to an “At-a-Glance” calendar that highlights upcoming events, deadlines, and payments.
• General Email Communications: Branded broadcast emails efficiently relay critical updates, policy changes, and deadlines to all participants, ensuring essential information is communicated without excessive volume.
• Targeted Email Communications: These emails can be sent as needed to specific participants regarding time-sensitive requirements to enhance clarity and reduce confusion related to compliance. For example, practices that have not signed a new amendment to the Participation Agreement or have not completed required reporting on time receive a reminder shortly before the deadline and subsequent notifications of the overdue task, with information of an extension period, if applicable. The list of target practices is updated before each round of communication, so practices that have, in the meantime, completed the requirement will not receive emails that do not apply to them.
• System Banner Messages: Banner messaging posted to participant portals effectively communicate important updates (e.g., the availability of upcoming practice-facing reports), and ensure participants are promptly informed of scheduled downtimes and deadlines in a user-friendly manner.
• Impact Evaluation: Outreach communications should be evaluated using various metrics—including email performance, newsletter engagement, open and click-through rates, and participant feedback from annual satisfaction surveys—to assess the relevance and appropriate frequency of communications to improve engagement.

3. Training & Technical Assistance (TTA)

A TTA framework should be used to deliver essential guidance and resources that help participants navigate the complexities of care transformation, payment methodologies, and model operational processes.

RTI employs a multi-modal TTA framework that consists of the following components:

• Diverse Educational Strategies: A range of educational formats, including written guides, toolkits, on-demand videos, live webinars, and office hours are used to accommodate varied learning preferences and ensuring timely access to information.
• Collaborative Resource Development: Partnering with SMEs and other model contractors (e.g., the Innovation Payment Contractor) helps create clear and engaging educational materials (e.g., methodology papers, guidelines, FAQs) that are regularly reviewed and updated to meet participants' evolving needs. Links to these materials are embedded in the bi-weekly newsletter, making them easy to access and reference.
• Interactive Learning Opportunities: Live webinars and office hours encourage real-time interaction, enabling participants to ask questions and clarify complex topics, thereby deepening their understanding of model requirements and policies.
• Continuous Feedback Integration: Participant feedback is actively collected through surveys and by monitoring help desk tickets to identify learning gaps and enhance TTA offerings. This ensures that resources remain relevant and effectively support participants in navigating model complexities.

4. Peer-to-Peer Platform

CMMI Connect is a collaboration and knowledge-management tool for peer-to-peer learning that fosters community among participants and facilitates the exchange of experiences and solutions. RTI coordinates with other CMS Innovation Center contractors to actively manage and promote alternative payment model participants' use of CMMI Connect.

Benefits of participant use and promotion of the platform include:

• Peer-to-Peer Collaboration: CMMI Connect serves as a vital electronic message board for participants to share experiences, promoting an "all teach all learn" approach.
• Active Monitoring and Response Management: RTI regularly monitors discussions on Connect. We intervene to provide timely responses to model operations-specific questions, clarify inaccurate information, or redirect participants to the help desk for assistance with their unique needs.
• Resource Repository: The platform provides a comprehensive, searchable library of resources, including FAQs and answers. Content is refreshed each model year and also updated ad hoc to reflect any mid-year policy changes. The repository also posts important announcements and includes an "At-a-Glance" calendar—updated monthly—to track key model dates and requirement deadlines.
• Collaborative Partnerships: Collaboration with other CMMI contractors enhances coordination and support across CMS-wide systems including the peer-to-peer platform, leading to improved model policies based on participant feedback and consistent messaging across support channels.

Drive Better Outcomes in APMs 

Successful participation in Medicare APMs requires an understanding of and adherence to model requirements. Our experience demonstrates that a model-specific help desk, effective communication vehicles and outreach, comprehensive training and resources, and peer collaboration are critical for empowering primary care practices to navigate new payment structures, meet model requirements and, ultimately, improve patient health care.