State-Based Payment and Delivery Reform
It is an exciting time in health care. As the nation's health care system continues to evolve, physicians have opportunities to help shape and participate in new payment and delivery models that better meet the needs of their patients and practices. The Advocacy Resource Center (ARC) is developing resources for state advocates with the goal of building sustainable physician practices that result in good health outcomes for patients and greater professional satisfaction for physicians.
Learn more about AMA’s work on payment and delivery and the resources available to physicians, advocates and other stakeholders.
Please contact Emily Carroll, JD, Senior Legislative Attorney, with any questions.
The AMA knows that in order for physician practices to stay viable, physicians must be able to evaluate and continually assess the impact of any payment system on their bottom lines. It will be impossible for physicians to track and manage these various payment systems without accurate, clear information about payment methodologies and related policies, actuarial information about the risk they are assuming and any risk adjustment methodologies being employed, as well as information about patient demographics, health status, utilization projections and other factors that will impact what they are paid.
The AMA has developed model legislation and a related issue brief designed to assist physicians when considering issues raised by new payment reforms at the state level. The model bill would require third-party payers to provide physicians with timely, accurate and comprehensive payment information sufficient enough to enable them to fully evaluate the financial impact to their practice.
To learn more about payment reform, view the AMA resources below:
States throughout the country are considering the appropriate legislative responses necessary to implement the new delivery models at the state level, and, specifically, the move to a more integrated and collaborative health care delivery system.
The ARC has developed model legislation for states to consider in their efforts to protect physician autonomy within the context of these delivery reforms. The model legislation requires that, regardless of the participants in an ACO or other coordinated care organization (CCO), physicians are given the responsibility and authority for establishing and overseeing all the organization’s medical policies. Additionally, the model bill establishes a Medical Policy Committee of the CCO’s Board of Directors (Board) which (1) is comprised solely of physicians who are practicing in the CCO and (2) has the full power of the Board to establish and maintain all of the CCO’s medical policies.
“Evaluating and negotiating emerging payment options” equips physicians with nuts and bolts information they will need to evaluate and negotiate current and emerging payment arrangements, as budget-based payment systems begin to augment or even replace the fee-for-service payment model.
“ACOs and other options: A ‘how-to’ manual for physicians navigating a post-health reform world” is specifically designed to help physicians maximize the likelihood of success, while minimizing the risk of failure, regardless of how they choose to navigate the new post-health reform world. Topics include an overview of accountable care organizations (ACOs) and issues to consider such as governance, partnerships with hospitals or health insurers and managing antitrust risks.
“Competing in the marketplace: How physicians can improve quality and increase their value in the health care market through medical practice integration” helps physician practices stay competitive through physician practice integration, while still complying with antitrust laws. This resource: (1) provides information about how physicians may consolidate or financially and clinically integrate their practices and (2) alerts physicians to the flexibility they have under current antitrust laws to lawfully come together.