Pay for Performance Will Work with a New Model of Care

Internists at the American College of Physicians Annual Session here got a more detailed look at the Advanced Medical Home (AMH) - a new model of patient care first described in a policy paper in January - and how that model should drive pay for performance. "Physicians have many concerns about pay-for-performance programs that link payment to quality, and the ACP believes pay for performance without other changes is not a solution. The AMH model includes a component of pay for performance and reflects our belief that pay for performance can have value if done correctly," said Michael S. Barr, MD, MBA, the College's Vice President, Practice Advocacy & Improvement.

The AMH model acknowledges that the best quality of care is provided not in episodic, illness-oriented, complaint-based care, but through patient-centered, physician-guided, cost-efficient longitudinal care. "This kind of care encompasses and values both the art and science of medicine. It is the kind of care that most of us went into medicine to practice and that our patients want to receive," said Barr.

The AMH is based on the chronic care model for improving outcomes, but it is believed that its benefits will extend to all patients and not just those with chronic illnesses. The model stresses redesigning a practice based on the concept that improved outcomes are a function of collaboration between an informed active patient and a team of prepared and proactive clinicians.

An AMH practice would organize the delivery of care for all patients according to the care model; use evidence-based medicine and clinical decision support tools; coordinate care in partnership with patients and families; provide enhanced and convenient access to care; identify and measure key quality indicators; use health information technology to promote quality, safety and security of information; and participate in programs that provide feedback on performance and accept accountability for process improvement and outcomes.

Later this year, the ACP will release another policy paper providing a framework for reimbursement. It will examine and recommend additional reforms that acknowledge the value of both providing and receiving coordinated care in a system that incorporates the elements of the "care model" and aligns incentives so that physicians and patients would choose medical practices that deliver care according to these concepts.