CHICAGO —As part of the ongoing implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), current advanced Alternative Payment Models (APMs) may inadvertently be creating disincentives for physicians to care for vulnerable or high-risk populations. To counter this outcome and work toward the American Medical Association (AMA) Health Equity Center’s goal of enabling optimal health for all, the AMA today adopted new policies at its Annual Meeting to support APMs that link quality measures and payments to outcomes specific to vulnerable and high-risk populations and reductions in health care disparities.
“We know that disparities in health outcomes are commonly related to non-medical factors, including geography and socioeconomic status, which are among the factors in the social determinants of health. To affect change and truly realize optimal health for all, we must encourage care to specifically meet the needs of vulnerable populations,” said William E. Kobler, M.D., an AMA board of trustees member. “If patients’ basic needs are not met, they are unlikely to stay healthy, regardless of the quality of care received. Because APMs are typically designed to be flexible to compensate for care that is not traditionally reimbursed, they present an opportunity to better care for and serve vulnerable populations.”
To address these concerns and incentivize care for vulnerable and high-risk populations, the AMA adopted three new policies:
- That the AMA support APMs that link quality measures and payment to outcomes specific to vulnerable and high-risk populations and reductions in health care disparities;
- That the AMA continue to encourage the development and implementation of physician-focused APMs that provide services to improve the health of vulnerable and high-risk populations;
- That the AMA continue to advocate for appropriate risk adjustment of performance results based on clinical and social determinants of health to avoid penalizing physicians whose performance and aggregated data are impacted by factors outside of the physician’s control
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