Business Models

A business model is the way in which a physician practice delivers services and generates revenue: operational processes, infrastructure, strategy, services performed and more. As physicians become more responsible for the overall cost-effectiveness and quality of patient care, practices will likely need to evolve to thrive. Learn about the business model options available to you.

Accountable care organizations

Governmental payers, the employer community and commercial health insurance companies are all pushing for more integrated health care delivery systems in which physicians and hospitals are held accountable for the overall cost and quality of care.

Regardless of the Medicare Accountable Care Organization (ACO) program’s success, it is likely that all physicians will need to participate in systems requiring more communication, care coordination and quality measurement reporting. Learn more about the various options physicians have in this changing environment, including the benefits and challenges associated with establishing or participating in physician and other health care provider collaboratives.

For a detailed overview of this issue, review ACO, CO-Ops and other options: A “How to” Manual for Physicians Navigating a Post-Health Reform World, as well as the following resources:

• Affordable Care Act – Summary of New Payment and Delivery Reform Models
• AMA CMS Report – Patient Centered Medical Home
• AMA Letter to HHS Accountable Care Act CO-OP Program

For more information on payment models related to the patient-centered care environment, be sure to check out the information and webinar on the Payment Model Resources for Physicians page.

Cash-based practices

Cash-based practices are models in which physicians lessen or eliminate their dependence on health insurance companies for payment of services. These approaches—whether going completely independent of insurance companies, simply developing practice policy that requires collection of patient co-payments at the time of service, or implementing some model in between—can help a practice lower administrative costs.

Cash-based Practices

Competing in the marketplace

Integration of physician practices through mergers or financial or clinical collaboration is an option physicians can explore to achieve efficiencies in our challenging and ever-changing health care environment. This publication gives an overview of these integration options, the antitrust issues such options may present, and how the AMA is advocating for physicians in matters of fair managed-care contracting. This publication provides legal information, but not legal advice.

Competing in the marketplace