3 Recommendations for Funding New Team-Based Healthcare Models

Physician-led, team-based models of care are the future of healthcare, according to the AMA, as evidenced by its successes in such healthcare organizations as Mayo Clinic, Geisinger Health System, Intermountain Healthcare and Kaiser Permanente.

With increasing numbers of large integrated healthcare 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.

The recommendations are as follows:

  • Physicians who lead team-based care in their practices receive payments for healthcare 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 (FFS) 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.”

With an aging population and a surge of newly-insured patients entering the system, they encourage other states to consider adopting this approach to helping facilitate the work of highly-functioning teams of medical professionals, AMA officials say.

Source: American Medical Association , November 18, 2013

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Case Study in Physician Practice and Payment Transformation: The CDPHP Experience chronicles the clinical and financial journeys of this network model health plan, sharing practical strategies and lessons learned from this two part-process.

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