Listen now (28 mins) | Listen Now Medicare's Fee for Service Alternative Payment Models (APMs), a creation of 2015 MACRA legislation, currently 12 in number with participation largely voluntary, requires Medicare providers to assume financial risk, based on historical spending and quality measurement performance, beyond a "nominal amount." The flagship APM is the ACA's Medicare Shared Savings Program, more commonly termed Accountable Care Organizations (ACOs). Though in its 8th year, the ACO program, that currently provides care to over 10 million assigned Medicare beneficiaries, has not produced meaningful savings (estimates are 1 to 2% annually). Nor have other APMs, largely bundled payment arrangements, produced substantial savings. The Medicare Advantage program (with one-third of Medicare beneficiaries), defined as administrative pricing, does not formally score savings. Over the past few years per capita Medicare spending has been limited, however, program growth or beneficiary enrollment (via the aging baby boomer population) is causing Medicare spending, in sum, to increase substantially. In addition, the soon-to-be-published annual Medicare Trustee's report will show the program will become insolvent within the next few years.