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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.

The Innovators Committee

The Innovators Committee
Front Row: Geraldine McGinty, MD; Gerald Maccioli, MD; Grace Terrell, MD; Peter Amadio, MD; Jane Dillon, MD Back Row: W. Douglas Weaver, MD; Philip Gaziano, MD; Michael Neuss, MD; Donald Liss, MD; Alan Speir, MD; Donald Klitgaard, MD; Keith Michl, MD Not Present: Michael Abecassis, MD; Steven Larson, MD

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.

Committee Composition
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.

Resources from the Innovators Committee

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.

Where Do I Fit In? Dividing the Pie in New Payment Models

Guiding Principles on Health Care Delivery and Payment Reform

The Case for Delivery Reform: Implementing Innovative Strategies in Your Practice

Physician Payment Reform: Early Innovators Share What They Have Learned

AMA Advocacy on New Payment Models

On March 16, 2015, AMA responded to CMMI request for information regarding Advanced Primary Care Model Concepts

On February 6, 2015 a sign-on comment letter in response to proposed policy and payment changes was submitted to CMS on Medicare Shared Savings Program (MSSP); Accountable Care Organizations (ACOs)

On February 6, 2015 a sign-on comment letter was submitted to CMS in response to MSSP; ACOs; Proposed Rule

On April 10, 2014, AMA responded to CMMI request for information on specialty practitioner payment model opportunities.

On February 28, 2014, AMA responded to CMMI request for information: Evolution of ACO Initiatives at CMS.

AMA Side-by-Side Chart on ACO/MSSP Final Rule

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.

AMA Principles on ACOs adopted by the House of Delegates at I-10

AMA letter to CMS on ACO's, Aug.12, 2010

Resources on payment and delivery
Payment Pathways White Paper

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.

Executive Summary

Full-text white paper

AMA Video on Accountable Care

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.

Watch the video.

CMS State Innovation Models Initiative

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:

Innovator Committee webinars

"Fee-For-Value Payments: Building the Entities to Effectively Manage Risk"
Originally recorded May 13, 2014
View archived recording.

"Fee-for-Value Reimbursements: The More Things Change, the More They Remain the Same"
Originally recorded April 8, 2014
View archived recording.

Archived webinars on payment innovation

Opportunities and challenges for physicians in shared savings, ACOs and other payment reforms
June 4, 2012

Listen to archived webinar

Harold Miller slide presentation

Final Medicare Rules for ACOs: Major new opportunities for physicians
Nov. 21, 2011

Listen to archived webinar

Payment Models Seminars

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.

What's Next? We Need Your Help

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 innovation@ama-assn.org.

Grace Terrell, MD
Grace Terrell, MD
president and CEO, Cornerstone Healthcare, primary care physician, member of AMA Innovators Committee.