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State-Based Payment & Delivery Reform

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As the U.S. health care system continues to evolve, physicians have a chance 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.

Payment Reform

The AMA knows that physicians must be able to continually assess and evaluate the impact of payment systems on their bottom lines in order for practices to stay viable. Physicians need accurate, clear information to best track and manage these various payment options. The information needed includes:

  • Payment methodologies and policies
  • Actuarial data about the risk they are assuming
  • Risk adjustment methodologies
  • Patient demographics
  • Health status
  • Projections

The AMA has developed model legislation and issue briefs 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 that enables them to fully evaluate the financial impact to their practice.

Learn more about evaluating and negotiating payment options.

Delivery Reform

States are considering appropriate legislative responses to best implement the new delivery models at the state level, as well as the move to a more integrated and collaborative health care delivery system.

The ARC has developed model legislation for state advocates to use in efforts to protect physician autonomy within these delivery reforms.

The model legislation requires that physicians are given the responsibility and authority for establishing and overseeing all the organization’s medical policies, regardless of participation in an Accountable Care Organization (ACO) or other coordinated care organization (CCO).

The model bill also establishes a Medical Policy Committee of the CCO’s Board of Directors (Board) that is comprised only of physicians who are practicing in the CCO and has the full power of the Board to establish and maintain all of the CCO’s medical policies.
 

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