AMA Resources Help to Understand New Payment Model in Commercial Payer Contracts

Commercial payers are increasingly pursuing contracts with physicians based on new payment models, such as pay-for-performance and bundled or episode-based payment. These alternative payment models can rely on both cost and quality metrics to determine payment rates for physicians. Navigating the assortment of new payer contracts can be made easier by gaining an understanding of payer agreements and the portions of those agreements that should be prioritized and can be negotiated.

The American Medical Association (AMA), in continuing its work to help physicians adapt to and succeed in the new world of alternative payment models, has developed two new resources that explain key issues physicians should consider when evaluating bundled or episode-based and pay-for-performance agreements.

Each of these documents outlines important considerations, including:

  • Summary of payment model
  • Contractual issues, including model language
  • Guidelines for evaluating risk and success

These documents are part of a continuum of resources the AMA is developing to ensure physicians are well equipped to succeed in our evolving health care environment. AMA membership is required in order to access these resources.

 
 

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