Wherever you are on the risk continuum, AMGA is your partner for value-based
care, with unrivaled resources and relationships for managing risk.
Making the shift from fee-for-service to value-based care is perhaps the most
transformative change a healthcare organization will ever make. It impacts every
aspect of your operations: care delivery, governance, technology, human
resources, compensation, and beyond. And with increased accountability for
managing the costs of care while improving patient health, it’s essential to get
AMGA guides organizations through this evolution like no other group.
Here you will find resources on the major risk models and best practices from
groups that are succeeding in taking on risk and delivering value-based care.
- Pay for Performance: The
pay for performance risk model delivers just that: financial incentives for
meeting specific quality and/or utilization measures. It’s where many
organizations start in assuming risk.
- Medicare Shared Savings
Program (MSSP): Through CMS’s multi-track Medicare Shared Savings Program (MSSP)
participants nationwide explored the accountable care organization (ACO) model
with Medicare fee-for-service beneficiaries. In Track One, ACOs share savings
but don’t incur losses held accountable for the quality, cost, and care
experience of an assigned population.
- Next Generation ACO: The
Medicare Next Generation ACO model offers greater opportunities for financial
risk and reward. Participants can use payments for incentives, infrastructure,
- Medicare Advantage: A type
of health insurance program within Part C of Medicare, where provider groups and
hospitals partner with insurance plans in shared savings plans and other shared
risk models to move away from fee-for-service payments and collectively drive
- MACRA: The Medicare Access
and CHIP Reauthorization Act of 2015 (MACRA), repealed the Sustainable Growth
Rate (SGR) payment system and its fee-for-service (FFS) reimbursement model,
with a new two-track system that requires physicians and clinicians to accept
downside risk: Merit-based Incentive Payment System (MIPS) and Alternative
Payment Models (APMs).
- Commercial Capitation:
Under capitation, assuming financial risk for the cost of care can yield a
variety of potential benefits: upfront cash flow, the ability to invest in
infrastructure and care model redesign, and increased capacity to move physician
incentives away from volume, to name a few.
Through our programs, resources, and valuable peer-to-peer networks, you’ll
find methodologies for process improvement and models for care and compensation.
For instance, AMGA is actively recruiting participants for our
Collaborative for Performance ExcellenceSM, a forum for our
members to use data and advanced analytics to achieve success in preparing for
risk-based contracts and driving clinical and operational efficiency. You’ll hear firsthand about tips for success—and impediments to progress—from
groups like yours.
AMGA: Your Partner for Value-Based Care. Contact
Bill Baron, 703.838.0033 ext. 336 to take
the next step.