Payment Design

Designing incentive structures to strengthen capacity, increase efficiency, and support high-quality care for individuals, families, and communities

“There comes a point when we need to just stop pulling people out of the river.  We need to go upstream and find out why they are falling in.”  Archbishop Desmond Tutu 

U.S. spending on health is inefficient and full of perverse misaligned incentives. The health care delivery system must transition reimbursement to models that value prevention, early interventions, social drivers of health, and high-quality patient and family-centered services. The human and economic cost of the current system’s fragmentation and reactionary financing structures are unsustainable. Alternative payment models (APMs) present opportunities to build care delivery models that value health outcomes while simultaneously can reduce costs and provider administrative burden. Third Horizon Strategies analyzes, designs, and supports the implementation of APMs and other incentive structures to create scalable solutions.

Through a macrosystem approach, Third Horizon Strategies deploys its subject matter expertise to design APMs that have the potential to increase access, improve the quality of the services, advance health equity, and incentivize the linkage of the continuum of care to improve health outcomes.

What We Do


Use data driven and evidence-based approaches to identify opportunities for sustainable improvements


Design models unique to the needs of the provider, payer, and patients that increase access and improve outcomes through high-quality care

Piloting and Scaling

Develop the infrastructure and provide expertise to run pilots and scale alternative payment models across the country


Define methodologies for rate setting approaches, attribution models, program roll-out, metrics, and evaluation or performance review to document, implement, and operationalize alternative payment models

Lead Contact

Ashley DeGarmo

Managing Director for Payment Design and Vice President of Client Services

Ashley DeGarmo is a health policy consultant with experience in alternative payment model development, strategic advisory, and expertise in behavioral health care.  Ashley oversees client engagements and manages operations across several areas of the firm, in addition to directing the work for the payment design advisory area.

Explore our other advisory areas

Behavioral Health

Enhancing behavioral health prevention, treatment, and recovery systems of care to improve access and quality

Community Health

Advancing the vitality of all communities through digital and person-centered solutions to strengthen health and social services

Market Analytics

Unlocking insights from new payer and provider pricing records, along with other data sets, to drive market efficiency and a transparent, patient-centric health care ecosystem

Workplace Well-being

Empowering organizations and their people with services and tools to navigate work and life in the healthiest way possible