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![]() Seek support from other physicians, physician groups, and patients.Ĭan CMS or private payers provide support to implement successful APMs? Identify mechanisms for ensuring adequacy of payment and Obtain and analyze data needed to demonstrate financial feasibility for practice, payers, and patients Identify measures of the aspects of utilization and spending that physicians can control ĭevelop a core set of outcomes-focused quality measures including mechanisms for regularly updating quality measures Understand the patient population, including non-clinical factors, to identify patients suitable for participation in an APM ĭefine services to be covered under an APM Identify potential solutions to reduce spending through improved care Identify barriers in the current payment system Identify leading health conditions or procedures in a practice The AMA recommends that the following guidelines are considered 2: Minimize administrative burdens on physician practices andīe feasible for physicians in every specialty and for practices of every size to participate in.Īre there guidelines to help medical societies and other physician organizations identify and develop feasible APMs for their members? Limit physician accountability to aspects of spending and quality that they can reasonably influence Īvoid placing physician practices at substantial financial risk Provide adequate and predictable resources to support the services physician practices need to deliver to patients, and should include mechanisms for regularly updating the amounts of payment to ensure they continue to be adequate to support the costs of high-quality care for patients Reduce burdens of Health Information Technology (HIT) usage in medical practice Promote physician-led, team-based care coordination that is collaborative and patient-centered Provide flexibility to physicians to deliver the care their patients need As such, the AMA supports that the following goals should be pursued as part of an APM 2:īe designed by physicians or with significant input and involvement by physicians The American Medical Association (AMA) recognizes that the physician is best suited to assume a leadership role in transitioning to alternative payment models (APMs). What goals should be pursued as part of an alternative payment model (APM)? Downstream effects to consider beyond ED and hospitalization include costs for medications, home health care, durable medical equipment (DME), and skilled nursing facilities. Patients in the practice whose conditions are not adequately controlled are more likely to cost your practice through no-shows, are less likely to adhere to their medications, and may call more frequently for medication refills than patients whose conditions are well managed. The positive impact has a ripple effect, where we are not only impacting their heart failure but their overall health.”Īre there other considerations I should make when evaluating opportunities to implement value-based care? ![]() ![]() This clinic has not only saved lives but has changed lives as well. “I have seen patients go from disengaged to self-motivated, from helpless to hopeful, from naïve to empowered by education and knowledge. Once you have this information, you can begin to develop your model. Understanding which patients drive your highest cost of care and those who use the ED frequently will help you to identify your target population and opportunities for improvement. These populations often include poly-chronic patients - those with chronic and complex conditions with multiple co-morbidities, such as diabetes, hypertension, depression, heart failure, cancer, kidney failure, or chronic obstructive pulmonary disease. Patient populations with the highest risk of hospitalization or high utilization of the emergency department (ED) tend to drive high health care costs and most often receive fragmented care. Quiz Ref ID Knowing your patients is the foundation of value-based care. Step 1 Identify your patient population and opportunity. ![]()
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