This toolkit will help leaders and organizations understand the principles underlying physician-led value-based care models. This toolkit includes step-by-step guidance for implementing value-based care, including how to identify high-risk patients, design a care model, and optimize team-based care in pursuit of a sustainable model for the practice.
Unlike traditional payment models that link payments to the number and type of services utilized, value-based health care is a delivery model in which payments to providers, including hospitals and physicians, are linked to patient health outcomes and quality. The “value” in value-based health care is derived from measuring health outcomes against the cost of delivering the outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.1 Value-based care may also be called an alternative payment model (APM).
Many organizations are striving to achieve the Quadruple Aim (Figure 1). By their very definition, value-based care models are designed to improve patient care, reduce costs, and yield better outcomes. While the relationship between care delivery models and well-being may not be apparent, delivering quality patient care is a principal driver of physician satisfaction and a contributor to well-being.
The Quadruple Aim
The American Medical Association (AMA) recognizes that the physician is best suited to assume a leadership role in transitioning to APMs.2 As such, AMA policy on physician alternative payment models can help you and your practice determine what is feasible.2
How many practices are using value-based care or alternative payment models?
The journey has been long, winding, and sometimes arduous, but today many more practices are reinventing their care delivery models to focus on quality over quantity. A 2022 American Academy of Family Physicians survey found that 49% of practices already participate in a value-based payment program, and 18% are figuring out how to make the transition.3 In 2020, 60% of health care payments had a quality and value component.3
Identify High Utilization, High-Risk Patient Populations
Design the Care Model
Optimize Team-Based Care to Sustain Your Model
Partner for Success
Drive Appropriate Utilization and Quantify the Impact
Knowing your patients is the foundation of value-based care. Patient populations with the highest risk of hospitalization or high emergency department (ED) utilization tend to drive high health care costs and often receive fragmented care. These populations include polychronic patients with multiple chronic and complex conditions and co-morbidities, such as diabetes, hypertension, depression, heart failure, cancer, kidney failure, or chronic obstructive pulmonary disease.
Utilizing evidence-based standards of care developed by medical specialty organizations can improve outcomes for the most common medical conditions that drive excess costs. Identifying patients with gaps in care can help prevent the deterioration of chronic medical conditions. Pull data from your patient care registry or electronic health record (EHR). For example, you may search for all patients with numerous ED visits within the last 2 years or patients with select chronic conditions such as uncontrolled diabetes or uncontrolled hypertension.
Categorizing patients by insurance status may also be informative. The Centers for Medicare & Medicaid Services (CMS) has set a goal for all Medicare fee-for-service and most Medicaid beneficiaries to be in a relationship with health care providers accountable for the quality and total cost of care by 2030.4 You may opt to target these populations for inclusion in your value-based care model.4 Many commercial insurers and employer-sponsored insurance plans are partnering with physicians to develop value-based care benefits for patients.
Remember, this is usually a transition, and it is important to identify tools and treatment-related services that benefit the fee-for-service (FFS) and fee-for-value (FFV) worlds. These services include the Medicare Annual Wellness Visit (AWV) and other preventive care, chronic care management, transitional care management, and collaborative care models—to name a few. These services all have FFS reimbursement attached but can help lower the cost of care through better managing unnecessary utilization and improving the quality of care delivered.
AMA STEPS Forward Simplified Outpatient Documentation and Coding Toolkit
This toolkit offers valuable documentation and coding tips and includes suggestions related to SDOH.
What other factors should I consider when my practice is evaluating opportunities to implement value-based care?
Compared to patients whose conditions are well-managed, patients whose conditions are not adequately controlled are:
More likely to cost your practice through no-shows
Less likely to adhere to their medications
More likely to call frequently for medication refills
More likely to experience reduced or fragmented continuity of care across multiple health care providers
Downstream effects to consider beyond ED and hospitalization include:
Costs for medications and potentially harmful drug-drug interactions
Home health care
Durable medical equipment (DME)
Care in skilled nursing facilities
How does patient insurance influence reimbursement or feasibility of an APM?
Your patients' insurance plans should not influence the quality of care they receive; however, the insurance plan does impact the services and benefits that can be offered to the patient to minimize their out-of-pocket expenses. Moreover, many insurance plans are incorporating value-based insurance design (VBID). VBID means that patients' cost-sharing can vary to encourage the use of high-value care or discourage the use of low-value care. This is an opportunity to align goals of value-based payment with clinical and financial incentives for patients.6- 8
Create a care model that is evidence-based and easy to follow. Several structures can support value-based care, including accountable care organizations (ACOs), patient-centered medical homes (PCMHs), or commercial and governmental payer contracts that pay for high quality, low cost, and improved outcomes in addition to the specific services rendered.
Consider the following elements to customize a value-based care model for your practice:
The target patient population(s) (refer back to STEP 1)
Payers who will be involved
Changes in the type and volume of services you offer
Compliance with federal and state laws
Anticipated or expected benefits for patients and payers; you can proactively work with insurance contractors in your organization's revenue cycle team to create and test VBC benefits
Existing or updated workflows necessary to provide the desired care to the selected patient population
Team members who will support the new model
Roles and responsibilities of each physician and the care team
Frequency of patient contact, including phone calls, emails, or portal messages
Frequency of direct patient contact from visits to clinical practices, urgent care, and telehealth or visits by home health providers
Available data sources to measure impacts, such as clinical, administrative, and payer or strategic partner data
Transition costs associated with implementing the new model—for example, funding for investments in new people, processes, and technologies required to support alternative payment models that a practice needs to plan for from the outset
The Physician-Focused Payment Model Technical Advisory Committee (PTAC) is crowdsourcing alternative payment model proposals from organizations, professional societies, health systems, and individual physicians across specialties.9 Check out the features of these submissions and consider how they might work in your model.
Examples of PTAC submissions include APMs that range from episode-specific to longitudinal, team-based management of patients with chronic conditions such as9,10:
Inflammatory bowel disease
Other APM designs submitted to PTAC enable higher quality, lower cost care delivery in9,10:
Home care (including acute hospital care at home)
Outpatient specialty care
The Health Care Payment Learning & Action Network (HCP LAN), composed of public and private health care leaders, is another resource for understanding and developing an alternative payment model that meets your needs.
The Centers for Medicare & Medicaid Services (CMS) has set forth strategic objectives for the future of value-based care that may also be guiding principles for your model (Figure 2).4
As you select or craft your new value-based care model, keep success metrics top-of-mind. Metrics for each population should be measurable and provide a baseline to assess against future impact. Select metrics that are easy to capture and automate in the electronic health record (EHR) or a population health registry to prevent having to extract them manually.
What is a typical development timeline for a brand-new care model vs a revised care model?
Timelines are contingent on the model chosen. The team could focus on approved clinical care pathways for disease-specific models, which could expedite implementation.
What barriers or hurdles should we anticipate as we move through this process?
One challenge to anticipate is the ability and willingness of payers and health care providers to agree on a defined, clear package of a protocol with treatment.
Another barrier to consider is the EHR alterations necessary to build the care model into the clinician's daily workflow. For smaller practices, this can be a real challenge. Many value-based care models require investments in additional personnel, such as care managers or community health workers, and will need up-front funding to support them.
What factors should we consider as we craft our model if we are in primary care?
Value-based care is a paradigm shift for many primary care physicians still working in an environment dominated by fee-for-service. The transition facilitates more comprehensive care but requires monitoring and evaluating defined outcomes that many primary care physicians are unaccustomed to tracking.11 Examples include11:
Rates of preventive screening services or management of chronic conditions
Measures of the total cost of care
Reductions in disparities for specific types of care
First, think about your capital, resource, and infrastructure needs. What will you need to invest in to track outcomes and enter data to demonstrate improvements? Is it training the care team? What about updating your EHR or investing in a registry? Larger practices with more capital and resources are often better positioned to deliver value-based care, but that doesn't mean a smaller practice cannot implement this model.
Second, think about how partnering can support your effort. Practices that participate in ACOs or PCMHs may have more success in a value-based care environment.11
Third, consider how you will integrate screening for SDOH and referrals to support services.11 Recognizing and addressing SDOH is crucial in achieving the desired outcome goals of value-based care.
Thoughtful planning and awareness of the characteristics of your practice's attributed patient population(s) are essential to assemble a cost-effective, appropriately staffed, and sustainable value-based care model.
By definition, value-based care teams are multidisciplinary teams. Depending on their licensure, background, and training—and with proper education and redistribution of responsibilities—current care team members could potentially fill the staffing needs of your new value-based care model.12 Leveraging the expertise of existing team members can be a cost-effective strategy during the initial transition period. As you expand the value-based care model, you might need to hire new team members, mainly because value-based models rely heavily on effective care coordination, care management, and robust data capture and analytics.
The care team leader should be a physician who identifies, engages, and elicits each team member's unique training, experience, and qualifications to help patients achieve their care goals.12 The physician leader should also supervise the application of these skills.12,13
Listen: One practice's success in implementing advanced team-based care
In this AMA STEPS Forward® podcast episode, Gregory Duke Carlson, MD, family medicine physician at TexomaCare in Denison, Texas, shares his experience incorporating advanced team-based care into an accountable care organization.
Related AMA STEPS Forward toolkits can help you recruit, train, and retain exceptional medical assistants who can fill some of the roles outlined in Table 2:
Medical Assistant Recruitment and Retention Toolkit
Medical Assistant Professional Development Toolkit
Given the significant involvement of numerous care team members, consider integrating the fundamentals of team-based care to ensure the success and sustainability of your value-based care model. For example, team efficiency and efficacy improve when the physician leads a brief daily huddle in the morning and involves the entire care team. This daily huddle anticipates any care management needs for that day and ensures the practice is adequately resourced to meet those needs.
What is the best staffing model for implementing value-based care?
There is no correct answer to this question. The best staffing model is tailored to your patients' needs and your practice's goals. Your practice should anticipate how many patients will benefit from the model and build the right team to achieve the chosen metrics effectively.
For example, a group practice found that a single nurse navigator could effectively address the needs of 250 patients at a time, even when many had polychronic and complex conditions. One person in a particular role may or may not be appropriate based on the health status of the patients within your population. You will want to continuously reevaluate your staffing to determine if patient needs are met, unnecessary costs are prevented, and that value-based care is viable long term.
No matter the staffing model, the health care team should be led by a physician, and the AMA recommends considering the following elements in creating it6:
Clinical roles and responsibilities
Which functions could be combined into a single role?
As long as the functions being performed are consistent with the scope of practice, education, and training of a given team member, roles can be combined, which is commonplace in many organizations. For example, a receptionist may also be the patient outreach coordinator trained to use the panel management tool to close gaps in care. A nurse may wear the hats of navigator, care coordinator, referral coordinator, and transitions manager.
Depending on the size of your practice or organization, you may need the additional resources a collaboration can offer to help you successfully shift to a value-based care model. Coordination with local hospitals, specialty practices, physical therapy service providers, skilled nursing facilities, urgent care centers, and payer partners are some strategic arrangements that may enhance your ability to offer patients better transitional care and outpatient care management. Consult with a legal advisor before establishing multi-provider structures to avoid running afoul of fraud, abuse, and other laws applicable to the health care space.
Collaboration and partnering avoid care fragmentation, which presents significant safety risks and can result in patient dissatisfaction and disengagement. Collaborating between hospitals and practices provides an ideal opportunity to reduce care fragmentation by enhancing coordination and communication. Through this collaboration, hospitals can offer discharge lists and reports on emergency department visits, enabling your practice to effectively follow up with patients and maintain continuity of care. Obtaining the daily ADT (Admission, Discharge, and Transfer) feeds from the facilities where your patients receive treatment, whenever feasible, is highly advantageous. These feeds can be integrated into your data and analytics platform or directed to a team pool EHR inbox that is accessible to the nurse navigator as part of their daily workflow.
Begin conversations with potential collaborators and payers by asking them to help you and the community make this move toward value together, for the benefit of your patients. Come to the table with a thoughtful business model that you can discuss and involve your legal advisors (Figure 3).
The Future of Sustainable Value-based Payment: Voluntary Best Practices to Advance Data Sharing
How could we partner with the Centers for Medicare & Medicaid Services (CMS) or private payers to help us implement our APM?
CMS and private payers may give technical support and advice to practices to facilitate a successful transition to an APM, such as assistance:
Designing and utilizing a team-based approach that divides responsibilities among physicians and supports allied health professionals
Obtaining the data and subsequent analysis necessary to monitor and improve performance
Forming partnerships and alliances to achieve economies of scale and to share tools, resources, and data without the need to consolidate organizationally
Obtaining the financial resources required to transition to new payment models and manage fluctuations in revenues and costs
CMS and private payers can also guide physician organizations seeking deemed status for replicable APMs, and in implementing APMs that have deemed status in other practice settings and specialties.
How can collaborating with other organizations help me improve patient care?
If you do not have privileges at a hospital, collaborating with a hospital could allow you access to your patients and their records when they are seen in the ED or admitted. Such arrangements may help reduce inpatient admissions and readmissions, ED visits, duplication of services, and drive care coordination. This also provides you with the opportunity to participate in transitional care planning.
Establishing collaborations with home health agencies, skilled nursing facilities, pharmacies, and other community resources is instrumental in promoting effective communication and cooperation among health care providers throughout the entire care continuum. Additionally, exploring a partnership with an independent practice association (IPA) can offer advantages in terms of resource sharing. It's important to note that provider collaborations and referral arrangements are subject to federal and state laws, necessitating the guidance of legal counsel.
Why should I consider payers as collaborators? Which payers reimburse for value?
Collaborating with payers allows you to align your clinical objectives for patients with insurance cost-sharing rules that promote the pursuit of high-value care. Collaborations that incentivize positive outcomes can lead to additional financial compensation for your practice and an opportunity to influence the insurance design for your patients. While not all value-based approaches immediately result in cost savings, adjustments can be made to the model as the collaborating parties learn and adapt. It's important to consider where any cost savings are directed, whether to external partners (such as hospitals or other entities), payers, physicians, or a combination of these stakeholders. Seeking legal counsel to review any contracts you are contemplating is advisable. Additionally, it's worth noting that achieving cost savings may take several years for some practices.
Some payers will have predetermined quality measures you must meet before receiving financial compensation, and you can build these into your value-based care model. Ideally, payer contracts should be negotiated so that the metrics or measures benefit both parties involved, and the patients served. It is important to negotiate payments and penalties prior to signing contracts with each payer to ensure the metrics selected are ones that your practice can track and achieve.
CMS and certain commercial payers now acknowledge the significance of care coordination, transitions of care, and integrated behavioral health as valuable services for some patients. They have started reimbursing appropriately coded claims for these services, provided that patients meet specified criteria. While these codes are reimbursed on a fee-for-service basis, they can generate revenue for practices that deliver high-value services to patients. One analysis found that a primary care practice could add more than $210,000 in revenue for appropriately billed preventive and coordination services if they adjusted coding for only 50% of their eligible Medicare patients.16 Therefore, practices transitioning to value-based payment models should consider evaluating the potential benefits of incorporating these codes. i
As your practice transitions to the new model, it is imperative to focus on reducing variability and directing utilization toward the desired lower-cost, high-quality approach. Patient choice and clinical needs ultimately determine where they receive care, even though staying within an integrated provider network generally improves quality and lowers costs.
Analyze to Reveal Variability and Opportunity
Take a holistic approach to analyze how the total cost of care can be improved. For instance, it may seem counterintuitive, but prescribing patients a more expensive medication that improves clinical outcomes may reduce downstream hospitalizations. Identifying and improving medication adherence may decrease the time spent on preauthorization for second- and third-line medications. To identify potential unnecessary costs associated with your practice, work with a financial expert or utilize analytic software to analyze high-cost spending patterns that do not contribute to better patient outcomes. For example, the analysis may uncover that an imaging center used by your practice is more expensive than others in the area. After evaluating service quality and ensuring value, referring patients to high-quality, lower-cost centers may be wise.
In today's environment, access to care is an increasingly pressing issue. Evaluate your office hours, availability of same-day appointments, and after-hours care options. If patients visit the ED for non-urgent care, there is an immediate opportunity to reduce the cost of care for your patient population. The COVID-19 pandemic has permanently reshaped health care, solidifying telehealth as a prominent solution to overcome some access limitations. Team-based telehealth can be a powerful tool for providing 24/7 patient care access, and many practices are forging strategic partnerships with telehealth providers.
AMA Telehealth Implementation Playbook
AMA Accelerating and Enhancing Behavioral Health Integration Through Digitally Enabled Care: Opportunities and Challenges Playbook
Keep in mind that there may be initial expenses involved in acquiring analytics programs or support. Before implementing any referral practices or changes, consult legal counsel to ensure compliance with relevant federal and state laws.
Leverage Team-Based Care Fundamentals
Beyond patient care, incorporating team-based practice fundamentals can aid in your quest to identify and eliminate unnecessary costs while improving practice efficiency. These fundamentals include pre-visit planning, team documentation, and advanced rooming and discharge.
When your team gains more authority and feels empowered to help patients manage chronic or polychronic conditions, collaborators will likely rely on your practice as the new model is adopted and refined. By implementing a more effective, team-based approach to care, outcomes should improve, allowing physicians to dedicate their time to new appointments, annual visits, and critical patients. Intermediate care, follow-ups, and education can be handled by other team members, with the approval of the physician team leader, and in accordance with each physician's preferences and applicable state regulations.
AMA STEPS Forward Saving Time Playbook
Measure, Refine, Repeat
Regularly review your practice's performance against established objectives monthly or quarterly, making necessary adjustments (Figure 4). Consider utilizing the Plan-Do-Study-Act (PDSA) method to monitor your progress.
What metrics and goal-setting resources can I use?
You could look to the following to set metrics and goals for your value-based care model:
The National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set® (HEDIS®)
Centers for Medicare & Medicaid Services (CMS) value-based programs
All identify nationally recognized quality metrics and goals each year. You can select the most relevant metrics for your patient population that are easily measured in your practice. You can also work with your patients' insurers to identify specific goals and metrics that are part of their value-based plans.
What are some examples of metrics that other practices have used?
Due to competition, this type of information is typically not shared. CMS and commercial payers could give you a list of metrics specific to your practice type to help you negotiate for value-based reimbursement.
What are the penalties in a value-based contract if I do not achieve my goals?
Whether your practice will be penalized for not meeting its goals depends on your contract. For example, there are upside-only contracts, which do not assess any penalties for failing to meet specific goals. Check whether savings are shared between the provider and the payer in these contracts.
Many value-based contracts involve financial penalties if performance standards are not met. For example, in a shared savings model where participants receive a share of the savings they generate for the payer, they may be required to repay a portion of the payer's losses if the model does not achieve savings. A practice must understand these downside financial risks before entering a contractual relationship. Especially in a total cost of care model, the downside risks may be linked to a proportion of total spending on the patient population, even if the share of spending attributed to physician services is relatively small.17
Physicians and other health professionals more easily influence some costs. One tactic to improve the likelihood of success is negotiating terms that tie downside risks to factors your practice organization has more control over. As you achieve success, it could be advantageous to transition towards risk-based contracts that incorporate potential penalties, as these contracts offer the greatest possibility of financial rewards. Before entering into any contracts, you should negotiate the potential gains and penalties that align with your capabilities and that you are willing to accept.
How can I involve patients in my new commitment to providing value-based care?
Patients can play a pivotal role in shaping the practice's value-based care model. If your practice has a patient and family advisory council, involve them in this improvement effort.
Patients have the potential to participate and take responsibility for their own health care actively when they know their health care team is committed to supporting them in these efforts. Engaging patients can be as straightforward as a simple phone call to high-risk patients between visits or connecting patients with a health coach to achieve their goals.
Speaking with patients is also helpful for identifying impediments to health equity in value-based care models that you might be unaware of, including literacy or language barriers, financial constraints, substance use disorders, and transportation hurdles. These discussions can be a first step in meeting the patient where they are to engage them in these new models of care.
Value-based care models are the future of sustainable health care. By shifting towards this model, your practice and your patients can reap the benefits of this outcomes-focused approach that incentivizes high-quality, patient-focused care and reduces overall health care costs.
Prioritize team communication and design roles that empower the care team. A team-based approach to care is vital to successfully implement a value-based care model. Keep everyone on the same page throughout the process. Foster a robust team culture and provide the team with authority within their scope to address the distinctive needs of each patient, thereby empowering them in their roles.
Utilize data to continue to improve. Do not underestimate the investment in IT infrastructure, applications, and database solutions required for the move to a value-based care model. When selecting a technology vendor, consider their depth of knowledge in clinical and administrative processes related to care models, contracting, and care coordination—not just analytics.
Engage patients throughout the process.
Communicate proactively with your patients as a provider and as a practice. Ensuring positive patient engagement and experiences in every interaction with you and your team is crucial for achieving positive outcomes in the transition to value-based care.
Journal Articles and Other Publications
What are the components of value-based care? AMA Health Systems Science. Renewed March 21, 2023. Accessed June 20, 2023. https://edhub.ama-assn.org/health-systems-science/interactive/18028223
Miller HD, Marks SS. A guide to physician-focused alternative payment models. American Medical Association and the Center for Healthcare Quality and Payment Reform. Accessed June 20, 2023. https://www.ama-assn.org/system/files/corp/media-browser/specialty%20group/washington/alternative-payment-models-physician-guide.pdf
Green DE, Hamory BH, Terrell GE, O'Connell J. A case report: Cornerstone Health Care reduced the total cost of care through population segmentation and care model redesign. Popul Health Manag. 2017;20(4):309-317. doi:10.1089/pop.2016.0105
Terrell GE. No pipe dream: achieving care that is accountable for cost, quality, and outcomes. N C Med J. 2016;77(4):269-275. doi:10.18043/ncm.77.4.269
Malâtre-Lansac A, Engel CC, Xenakis L, et al. Factors influencing physician practices' adoption of behavioral health integration in the United States: a qualitative study. Ann Intern Med. 2020;173(2):92-99. doi:10.7326/M20-0132
Accountable care organization (ACO) Realizing Equity, Access, and Community Health (REACH) model. CMS.gov. February 24, 2022. Accessed June 27, 2023. https://www.cms.gov/newsroom/fact-sheets/accountable-care-organization-aco-realizing-equity-access-and-community-health-reach-model
Lewis C, Horstman C, Bluementhal D, Abrams MK. Value-based care: what it is, and why it's needed. The Commonwealth Fund. February 7, 2023. Accessed June 27, 2023. https://www.commonwealthfund.org/publications/explainer/2023/feb/value-based-care-what-it-is-why-its-needed
Pandey A, Eastman D, Hsu H, Kerrissey MJ, Rosenthal MB, Chien AT. Value-based purchasing design and effect: a systematic review and analysis. Health Aff (Millwood). 2023;42(6):813-821. doi:10.1377/hlthaff.2022.01455
Horstman C, Lewis C. Engaging primary care in value-based payment: new findings from the 2022 Commonwealth Fund survey of primary care physicians. The Commonwealth Fund. April 13, 2023.Accessed May 25, 2023. https://www.commonwealthfund.org/blog/2023/engaging-primary-care-value-based-payment-new-findings-2022-commonwealth-fund-survey
Teisberg E, Wallace S, O'Hara S. Defining and implementing value-based health care: a strategic framework. Acad Med. 2020;95(5):682-685. doi:10.1097/ACM.0000000000003122
Liao JM, Navathe AS, Werner RM. The impact of Medicare's alternative payment models on the value of care. Annu Rev Public Health. 2020;41:551-565. doi: 10.1146/annurev-publhealth-040119-094327
Lewis C, Horstman C, Blumenthal D, Abrams MK. Value-based care: what it is, and why it's needed. The Commonwealth Fund. February 7, 2023. Accessed May 23, 2023. https://www.commonwealthfund.org/publications/explainer/2023/feb/value-based-care-what-it-is-why-its-needed
Abrams MK, Nuzum R, Zezza MA, Ryan J, Kiszla J, Guterman S. The Affordable Care Act's payment and delivery system reforms: A progress report at five years. The Commonwealth Fund. May 7, 2015. Accessed May 25, 2023. http://www.commonwealthfund.org/publications/issue-briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-years
Gerhard W, Korenda L, Morris M, Vadnerkar G. The road to value-based care: Your mileage may vary. Deloitte Center for Health Solutions. May 11, 2015. Accessed May 23, 2023. https://www2.deloitte.com/content/dam/insights/us/articles/value-based-care-market-shift/DUP-1063_Value-based-care_vFINAL_5.11.15.pdf
Characteristics of a rational Medicare payment system. American Medical Association. 2022. Accessed June 20, 2023. https://www.ama-assn.org/system/files/characteristics-rational-medicare-payment-principles-signatories.pdf
Payments for accountable specialty care or “PASC.” American Medical Association. 2022. Accessed June 20, 2023. https://www.ama-assn.org/system/files/apm-payments-accountable-specialty-care-pasc.pdf
Rosenthal MB, Alidina S, Ding H, Kumar A. Realizing the potential of accountable care in Medicaid. The Commonwealth Fund. April 12, 2023. Accessed May 25, 2023. https://www.commonwealthfund.org/publications/issue-briefs/2023/apr/realizing-potential-accountable-care-medicaid
Porter ME, Lee TH. The strategy that will fix health care. Harvard Business Review. October 2013. Accessed May 24, 2023. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care
Nussbaum S, McClellan M, Metlay G. Principles for a framework for alternative payment models. JAMA. 2018;319(7):653–654. doi:10.1001/jama.2017.20226
Ouayogodé MH, Fraze T, Rich EC, Colla CH. Association of organizational factors and physician practices' participation in alternative payment models. JAMA Netw Open. 2020;3(4):e202019. doi:10.1001/jamanetworkopen.2020.2019
Delivering value-based care means hiring service-oriented staff. Medical Economics. March 25, 2016. Accessed May 24, 2023. https://www.medicaleconomics.com/view/delivering-value-based-care-means-hiring-service-oriented-staff
Must hospitals send ADT notifications to physicians' EHR inbox? American Medical Association. May 5, 2023. Accessed May 23, 2023. https://www.ama-assn.org/practice-management/sustainability/must-hospitals-send-adt-notifications-physicians-ehr-inbox
Medicare alternative payment models. American Medical Association. Updated January 31, 2023. Accessed June 20, 2023. https://www.ama-assn.org/practice-management/payment-delivery-models/medicare-alternative-payment-models
Evaluating pay-for-performance contracts. American Medical Association. 2018. Accessed June 20, 2023. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/member/about-ama/pay-performance-contracts.pdf
Evaluating bundled or episode-based contracts. American Medical Association. 2018. Accessed June 20, 2023. https://www.ama-assn.org/system/files/corp/media-browser/public/about-ama/bundled-episode-based-contracts_0.pdf
Evaluating Medicare Advantage value-based contracts. 2019. Accessed June 20, 2023. https://www.ama-assn.org/system/files/2019-04/medicare-advantage-value-based-contracts.pdf
Where do I fit in? Dividing the pie in new payment models. American Medical Association. April 2014. Accessed July 20, 2023. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/wash/innovators-committee-physician-payment-reform-white-paper.pdf
Value-based care models: deep dive FAQs for hospital-affiliated physicians. American Medical Association. 2018. Accessed July 20, 2023. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/physicians/macra/hospital-affiliated-faqs.pdf
Related American Medical Association Policies
Value-based decision-making in the health care system H-450.938. American Medical Association. 2021. Accessed June 20, 2023. https://policysearch.ama-assn.org/policyfinder/detail/value-based%20care?uri=%2FAMADoc%2FHOD.xml-0-4062.xml
Physician-focused alternative payment models: reducing barriers H-385.908. American Medical Association. Last modified 2020. Accessed June 20, 2023. https://policysearch.ama-assn.org/policyfinder/detail/APM?uri=%2FAMADoc%2FHOD.xml-H-385.908.xml
Moving to alternative payment models H-450.931. American Medical Association. Last modified 2020. Accessed June 20, 2023. https://policysearch.ama-assn.org/policyfinder/detail/alternative%20payment%20model?uri=%2FAMADoc%2FHOD.xml-0-4055.xml
Accountable care organization principles H-160.915. American Medical Association. Last modified 2019. Accessed June 20, 2023. https://policysearch.ama-assn.org/policyfinder/detail/payment%20principles?uri=%2FAMADoc%2FHOD.xml-0-730.xml
Pay-for-performance principles and guidelines H-450.947. American Medical Association. Last modified 2022. Accessed June 20, 2023. https://policysearch.ama-assn.org/policyfinder/detail/payment%20principles?uri=%2FAMADoc%2FHOD.xml-0-4071.xml
Aligning clinical and financial incentives for high-value care D-185.979. American Medical Association. Last modified 2022. Accessed June 20, 2023. https://policysearch.ama-assn.org/policyfinder/detail/value-based%20payment?uri=%2FAMADoc%2Fdirectives.xml-D-185.979.xml
Health Care Payment Learning & Action Network (HCPLAN). Accessed June 27, 2023. https://hcp-lan.org/
Building successful value-based partnerships. Healthcare Transformation Task Force. September 1, 2017. Accessed May 23, 2023. https://hcttf.org/building-successful-value-based-partnerships/
Value-based care. Medical Economics. Accessed May 24, 2023. https://www.medicaleconomics.com/topics/value-based-care
Debunking regulatory myths. American Medical Association. April 10, 2023. Accessed May 23, 2023. https://www.ama-assn.org/practice-management/sustainability/debunking-regulatory-myths
Major physician measurement sets. Agency for Healthcare Research and Quality (AHRQ). Last reviewed January 2023. Accessed May 24, 2023. https://www.ahrq.gov/talkingquality/measures/setting/physician/measurement-sets.html
AMA PolicyFinder. Accessed May 23, 2023. https://policysearch.ama-assn.org/policyfinder
Value Transformation Framework. National Association of Community Health Centers. Accessed June 26, 2023. https://www.nachc.org/clinical-matters/value-transformation-framework/
Principles for Medicare physician payment reform. American Medical Association. Updated September 20, 2022. Accessed June 20, 2023. https://www.ama-assn.org/practice-management/medicare-medicaid/principles-medicare-physician-payment-reform
Community health worker (CHW) networks and training programs. National Association of Community Health Workers (NACHW). Accessed June 20, 2023. https://nachw.org/membership/chw-networks-and-certification-programs/
Quality Payment Program (QPP) specifics. American Medical Association. Updated July 26, 2022. Accessed June 20, 2023. https://www.ama-assn.org/practice-management/medicare-medicaid/quality-payment-program-qpp-specifics
Woodard L, Gronseth S, McNeil SG. Value-based care: introduction to value-based care and the U.S. healthcare system. Coursera. https://www.coursera.org/learn/value-based-care-introduction
Move to value. https://www.chesshealthsolutions.com/move-to-value-podcast/
Race to value. https://www.racetovalue.org/
Relentless Health Value™. https://relentlesshealthvalue.com/
The value-based healthcare podcast. Reveleer. Listen on Apple Podcasts | Listen on Spotify
Value-based care insights. Lumina Health Partners. Listen on Apple Podcasts | Listen on Spotify
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