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Physician Payment & Delivery Models

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The federal government and private payers are changing the way they pay physicians and other health professionals by moving towards innovative models intended to improve quality and reduce costs. An AMA-RAND study investigates the real-world impact of these payment reforms on physician practices. The study findings are guiding the AMA’s efforts to improve alternative physician payment models and to help physician practices successfully adapt and succeed.

Alternative Payment Models (APMs)

Prepare for changes happening through the Medicare Access & CHIP Reauthorization Act.

Access resources and information to understand Medicare payment and delivery reform under Medicare Access and CHIP Reauthorization Act (MACRA).

Learn how 7 potential alternative payment models (APMs) could help physicians in every specialty improve patient care, manage health care spending and qualify for APM annual bonus payments.

Is the Pay-for-Performance or the Bundled Payment Model Right for My Practice?

Many commercial payers are pursuing pay-for-performance and bundled or episode-based, contracts with physicians. Determining whether either fits your practice begins with understanding their contracts. Download the new contract tools and learn:

  • What these payment models are
  • Which model concepts and contract issues you need to know
  • How you can evaluate these models’ risks and effectiveness

Resources

The AMA has a number of resources to help physicians adopt reforms, PowerPoint presentations, and papers developed by experts and early innovators in new payment models.

Where Do I Fit In? Dividing the Pie in New Payment Models (PDF): Learn about fee-for-value (FFV) payment arrangements from how to transition to an FFV model to adopting payments innovations that reward high-value care.

Effects of Health Care Payment Models on Physician Practice in the United StatesA report from the RAND Corporation commissioned by the AMA took an in-depth look at the impact that various payment models have on physician practices, their professional lives and the delivery of patient care and assessed the impact of alternative payment models on practices and individual physicians.

Measuring and Assigning Accountability for Healthcare Spending (PDF): A report from the Center for Healthcare Quality and Payment Reform describes 6 fundamental problems with the current attribution and risk adjustment systems that are being used in a number of the payment systems implemented by Medicare and private health plans and explains how these problems could seriously harm both patients and health care providers.

The Building Blocks of Successful Payment Reform: Designing Payment Systems That Support Higher Value Care (PDF): A report developed by the Center for Healthcare Quality and Payment Reform describes a 10-step process for developing such a business case and provides a detailed example for how to apply the process to an initiative to improve management of chronic disease patients. The report also describes the types of data that are needed to carry out all of the steps in a good business case analysis.

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