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AMA Turns Its Attention to New Payment Models

November 19, 2013
by John DeGaspari
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Passes recommendations that support new approaches to team-based healthcare

The American Medical Association (AMA) has adopted new recommendations for creating payment mechanisms to sustain what it describes as team-based health care delivery models that it says are emerging as the preferred method for providing coordinated, cost-effective, high-quality health care for patients.

“The success rate of physician-led team-based models of care has been proven time and again by trusted industry leaders like the Mayo Clinic, Geisinger Health System, Intermountain Healthcare and Kaiser Permanente,” said AMA President Ardis D. Hoven, M.D., in a prepared statement.

According to the AMA, physician-led, team-based models are successfully improving quality and reducing costs by leveraging integrated, coordinated, physician-led teams of health care professionals to provide comprehensive patient care through health care delivery systems. It cites as an example a physician-led medical home associated with Blue Cross Blue Shield of Michigan which recently released preliminary data showing a $155 million savings in 2012, and a total of $310 million saved since 2008.

With increasing numbers of large integrated health care systems, health insurance companies and physician practices of all sizes establishing these models, the AMA has been actively working to provide guidance on implementation, including a report outlining recommendations for the development of payment mechanisms that promote satisfaction and sustainability of team-based models in various practice settings. In the report the AMA calls for:

  • Physicians who lead team-based care in their practices receive payments for health care services provided by the team and to establish payment disbursement mechanisms that foster physician-led team-based care;
  • Physicians make decisions about payment disbursement in consideration of team member contributions, including factors such as volume and intensity of the care provided, the profession, training and experience of each team member and the quality of care provided; and
  • Payment systems for the physicians-led team-based care: to reflect the value provided by the team, with the savings accrued by this value shared by the team; to reflect the time, effort, intellectual capital provided by individual team members; to be adequate to attract team members with the appropriate skills and training to maximize the success of the team; and, to be sufficient to sustain the team over the time frame that is needed.

To further aid implementation of these new models, the AMA also passed a report that more specifically defines team-based roles and concepts including “physician-led,”  “supervision” and “collaboration.”

 

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