Background

In 2005, American Medical Group Association initiated the Results-Based Payment System Initiative (RPS), a multi-year endeavor to consider (a) the current, flawed reimbursement model in America's healthcare delivery system, (b) the premises and barriers to designing and creating a new reimbursement system based upon the receipt of quality in care, and (c) the development of strategies that will lead to the implementation of a results-based reimbursement system.

The broad aim goals of the initiative is to support enhancements in health by developing new incentive systems for practitioners in which a significant portion of compensation is linked to results of health care linked to quality measures. America’s current payment system for health care is based upon paying for services delivered without recognition of whether the care is outstanding, average, or poor. Said otherwise, Practitioner A and Practitioner B are reimbursed identically for delivering the same services, regardless of the differences in the quality of care they deliver. Additionally, there is no recognition or reward for the timeliness, appropriateness, or outcome of the care delivered.

The RPS initiative seeks to develop a new model for reimbursement, based on improved health care delivery with regard to efficiency, timeliness, quality, appropriateness, and other factors. Results-based payment moves beyond today’s pay-for-performance (P4P) models, which base reimbursement on adherence to protocols and checklists. The RPS approach is more expansive, including measures outside the parameters of P4P protocols.

RPS incorporates care coordination, quality, outcomes, and the patient’s role in the health care process. It rewards a systems approach on both organizational and clinical levels, and applies transparent metrics to process, efficiency, and outcome. The determination of payment would include such factors as case mix, risk-adjustment, and patient satisfaction. This system would promote coordinated care, technologic innovation, and continuous learning, and would increase accountability for all stakeholders in health care.

AMGA assembled a Steering Committee of health care thought leaders to begin defining and developing the goals of RPS. As materials from their deliberations are developed, they will be posted on this site.

Website Terms and Conditions of Use and Privacy Policy