Next Generation Physician Payment and Delivery Models
The AMA is developing resources for physicians interested in payment and delivery reforms to achieve physician-led patient-centered care, improved physician satisfaction, better coordination between specialists and primary care, and better margins.
Changes in federal health policy have provided for a range of new pilot programs, including accountable care organizations, medical homes and bundled payments. The lessons learned from these pilots will form the roadmap for major payment and delivery reforms in Medicare. To help physicians adopt these reforms, AMA resources include webinars, PowerPoint presentations, in-person seminars and papers developed by experts in the new payment models and early innovators.
Registration now open for July 18 webinar!
“Building New Payment Models and Getting Paid”
July 18, 7 p.m. Eastern
Innovators explore how physicians can design new payment models that work for their practices.
April 2 webinar archive—now posted!
"Delivery Reform Implemented? Payment Models that Reward Your Performance"
Originally recorded April 2, 2013. The archived recording is now available for AMA PRA Category I Credit.
In June 2011, AMA formed the Innovators Committee, an advisory group of physicians with hands-on experience in the development and management of innovative delivery and payment models. Their experience guides the development of AMA resources to help physicians enact innovations that improve patient care and increase their professional satisfaction and success.
While the 14 Innovators were chosen primarily for their experience, the Committee's composition reflects physicians from a broad range of states, specialties, and practice settings. Learn more about the members of the Committee.
On April 10, the Centers for Medicare & Medicaid Services announced the names of the first 27 accountable care organizations (ACOs) participating in the agency's Shared Savings Program.
Serving an estimated 375,000 Medicare patients in 18 states, the majority of the new ACOs are led by physicians. The AMA attributes this strong showing of physician participation to program changes CMS made at the AMA's request, which allowed greater opportunities for physicians to lead ACOs, including the Advance Payment ACO Model.
CMS also announced that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources.
5 Advanced Payment ACOs announced April 10:
- Coastal Carolina Quality Care, Inc. (New Bern, N.C.)
- Jackson Purchase Medical Associates, PSC (Paducah, K.Y.)
- North Country ACO (Littleton, N.H.)
- Primary Partners, LLC (Clermont, Fla.)
- RGV ACO Health Providers, LLC (Donna, Texas)
27 ACOs participating in Shared Savings Program
ACO Resources for Physicians
The Innovators Committee has developed a series of resources offering practical guidance to physicians on how to implement delivery and payment reforms by describing early Innovator experiences in the form of case studies.
Pathways for physician success under healthcare payment and delivery reforms
The AMA commissioned a white paper by Harold D. Miller, a nationally recognized expert on accountable care organizations, regional health improvement collaboratives and other innovations in health care delivery. The paper, titled “Pathways for physician success under healthcare payment and delivery reforms,” explains the many ways that innovative payment models can translate into positive opportunities for physicians.
This video, taped during the AMA’s 2011 National Advocacy Conference in February, features a stimulating and informative presentation from Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, on the new physician payment models presented in the Affordable Care Act. Miller explores how physicians can lead and find success with new payment and delivery models, such as accountable care organizations and episode-of-care bundled payments.
In the 80-minute presentation, featuring an introduction from former AMA President J. James Rohack, MD, Miller gets beyond conceptual discussions of the proposed models and explores them through the lens of actual provider care scenarios. A lively Q&A session follows his presentation.
In July, CMS announced a new initiative for States to design and test improvements to their health care systems that would bolster health care quality and decrease costs. The State Innovation Models initiative (SIM) is a competitive funding opportunity for State governments to design and test multi-payer payment and delivery models that deliver high-quality health care and improve health system performance. The deadline for state governments to apply for CMMI funding is September 24th. CMS is urging states to seek input from key stakeholders, including physicians, to these state planning grants and model testing awards. To assist organized medicine in this effort, the AMA has developed a fact sheet and other resources, with additional resources to be posted in the near future:
Building new payment models and getting paid
Speakers: Philip Gaziano, MD and Harold Miller, Center for Healthcare Quality and Payment Reform
Talk of bundling payments never gets very far before any number of challenges threaten to slow progress. There is no doubt that designing and implementing payment bundles is tough work that forces physicians and other providers to work together to address issues ranging from episode definitions and length, payment attribution and control, risk adjustment, and high-cost outliers. The good news is that many physicians have overcome these challenges to design successful episode and global bundles in operation today. Get the inside scoop from early innovators on the data and analytic tools necessary to design payment bundles across settings of care that will work for your practice.
Opportunities and challenges for physicians in shared savings, ACOs and other payment reforms
June 4, 2012
Final Medicare Rules for ACOs: Major new opportunities for physicians
Nov. 21, 2011
This seminar series, "AMA Pathways to Success: What physicians need to know about ACOs and the coming revolution in payment practices," will explain how physicians can lead new payment and delivery models, such as accountable care organizations and episode-of-care bundled payments, being tested in Medicare and adopted in the private sector.
Keynote speaker, Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, and other national and local experts, will explore how physicians can find success with new payment practices.
On June 16, 2011 the AMA submitted comments to the Center for Medicare and Medicaid Innovation (CMMI) on the concept of an Advance Payment Initiative for ACOs entering the Medicare Shared Savings Program.
On June 3, 2011 the AMA submited comments to HHS and CMS on the Medicare Shared Savings Program.
On June 3, 2011 the AMA sumbitted comments to the CMS on their proposed rule on Medicare ACOs.
On May 26, 2011 the AMA submitted comments to the Federal Trade Commission and the Department of Justice on the proposed Statement of Antitrust Enforcement Policy regarding ACOs participating in the Medicare Shared Savings Program.
On April 26, 2011, the AMA sent a letter to the House Energy and Commerce Committee on physician payment reform.
On April 8, 2011, the AMA sent this memo to state, county and specialty medical societies summarizing the proposed ACO regulations that were released on March 31.
Full text of the ACO Proposed Rule.
On December 2, the AMA submitted comments to a CMS Request for Information on ACOs outlining concrete recommendations for developing physician-led ACOs.
On October 5, the Federal Trade Commission, HHS Office of Inspector General, and the Centers for Medicare and Medicaid Services (CMS) convened a joint workshop on legal issues involved in accountable care organizations (ACOs) and the AMA provided these comments at the worshop.
On August 24, the Centers for Medicare and Medicaid Services held a call with interested organizations to solicit their thoughts on accountable care organizations. The AMA presented these talking points on the call.
The AMA wants to identify other innovative reforms taking place around the country that are being developed and led by physicians. If you are involved in new payment and delivery models, please tell us about your program by emailing firstname.lastname@example.org.