SOURCE: American Medical Association

American Medical Association

November 18, 2013 18:38 ET

AMA Passes Recommendations for Payment Models That Support New Approaches to Team-Based Health Care

WASHINGTON, DC--(Marketwired - November 18, 2013) - Team-based health care delivery models are quickly emerging as the preferred method for providing coordinated, cost-effective, high-quality health care for patients and today the American Medical Association's House of Delegates adopted new recommendations for creating payment mechanisms to sustain these promising new models of care.

"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 the words of Dr. William Mayo, 'It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient.' The AMA and the broader physician community firmly believe that this approach represents the future of health care delivery in America."

Unlike insular models, 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. Numerous pilots around the country are leading the way and achieving much success, including 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 much-needed 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; 
  • 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.

Fee-for-service payments will be an option for physician practices for the foreseeable future, yet payment models continue to shift their focus away from volume-based payment structures and toward those based on value, which are used for team-based delivery models such as episode-based bundled payments, global bundled payment systems, pay-for-performance programs, care management models, shared savings arrangements, combinations of incentives coupled with base salaries, and others.

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

"Virginia recently adopted a law that supports and promotes physician-led health care teams as a collaborative, consultative approach to health care," said Dr. Hoven. "With an aging population and a surge of newly-insured patients entering the system, we encourage other states to consider adopting this innovative approach to helping facilitate the work of highly-functioning teams of medical professionals who can meet the growing demand for health care." 

About the AMA

The American Medical Association is the premier national organization dedicated to empowering the nation's physicians to continually provide safer, higher quality, and more efficient care to patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America.

Contact Information