CMS’ New APM Performance Pathway (APP): What It Is & Why It Matters

CMS’ New APM Performance Pathway (APP): What It Is & Why It Matters

CMS APM APP

The Centers for Medicaid and Medicare Services (CMS) has created a new reporting pathway in an effort to encourage the transition to alternative payment models by tying financial incentives to broader value-based care goals.

The Alternative Payment Model (APM) Performance Pathway (APP) is a new reporting and scoring option for Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and Merit-based Incentive Payment System (MIPS) eligible clinicians that participate in MIPS APMs. When your reimbursement hinges on your reported performance, it’s imperative you understand program changes to align, prepare and succeed.

Why should you care about the APP?

Leaders know that the industry is dynamic, and that transformative change is imminent to address the cost and quality concerns of our health care system. If you are a MSSP ACO, you should be aligning now, as of January of this year you must report via the APP. If you are a MIPS APM participant, it may still be optional to use the APP but taking a proactive approach now while program conditions are optional helps you avoid the need to reshape your organization’s culture and processes under fast-moving changes in program conditions. What’s more is that CMS is encouraging you to use the new APP by providing multiple incentives for you to make the transition now. Let’s dig in.

ACOs participating in the Medicare Shared Savings Program are required to report through the APP for purposes of assessing their quality performance.

Leaders know that the industry is dynamic, and that transformative change is imminent to address the cost and quality concerns of our health care system. If you are a MSSP ACO, you should be aligning now, as of January of this year you must report via the APP. If you are a MIPS APM participant, it may still be optional to use the APP but taking a proactive approach now while program conditions are optional helps you avoid the need to reshape your organization’s culture and processes under fast-moving changes in program conditions. What’s more is that CMS is encouraging you to use the new APP by providing multiple incentives for you to make the transition now. Let’s dig in.

 -2021 APM Performance Pathway Quick Start Guide

What is the APP?

The most significant changes in the APP exist within the quality category as CMS wanted the measures to reflect the diversity of the practice types more accurately and to lessen the reporting burden. Whereas other programs and reporting pathways had more complex requirements, the APP has a pre-determined set of measures.

For 2021, the set of measures is dependent on how you want to report. For MSSP ACOs, you can either select to report the 10 CMS Web Interface measures, or the 3 quality measures. The below diagram identifies what specific measures you are required to report for each option.

quality measures

You should know that the CMS Web Interface is scheduled to be decommissioned at the start of 2022. This means while here in 2021 you have the option of which path you choose, starting in 2022, MSSP ACOs must report eCQMs via a Third-Party Intermediary – a CMS Qualified Registry or an Electronic Health Record System.

2021 APP Benefits

Beyond having to report less measures, using the APP also offers two big benefits for your final score. As you can see in the below diagram, using the APP is considered your improvement activity for the year, so you will automatically receive 100% score for this category. In addition, the cost category is weighted to 0% as it is already built into your APM contract.

All health care organizations are different, so leaders must understand industry changes and the context for which program conditions apply within their own organizations. However, we see a trend across sectors to adopt more efficient means of reporting through eCQMs. Finding the right partner that can successfully calculate and report your measures, like KPI Ninja as a multi-year NCQA eCQM Certified vendor in addition to providing end-to-end analytics to improve the measures, sets you up for success with your value-based contracts.


Renee Towne

About the Author
Renee Towne
Director of Quality Programs at KPI Ninja, Inc.
Renee provides operational leadership of quality initiatives at KPI Ninja. Towne has a background in occupational therapy, education and experience in operational excellence across a variety of healthcare domains. Based on prior experience as a clinician that drove outcomes patient by patient, she is leaving a larger footprint by improving health care more comprehensively, population by population.


About KPI Ninja
KPI Ninja is a data analytics company that helps healthcare organizations accelerate their quality, safety, and financial goals with a unique combination of software and service. We are differentiated by our signature mix of technology, performance management consulting and healthcare expertise. We don’t merely offer software solutions but work shoulder to shoulder with clients to help them draw on the power of analytics and continuous improvement methodologies to become more efficient. In harmony with our data-centered ethos, we truly believe that our success is strongly co-related with yours.

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