Physician-initiated payment reform: a new path toward value

Area of Science:

• Health Policy
• Healthcare Economics
• Medical Practice Management

Background:

• Value-based payment reforms are increasingly common, historically driven by payers and focused on primary care.
• A new phase involves physicians, particularly specialists, designing their own alternative payment models (APMs).
• The Physician-Focused Payment Model Technical Advisory Committee, established by MACRA, facilitates this physician-led reform.

Purpose of the Study:

• To analyze the content and themes of physician-designed APM proposals.
• To understand provider perspectives on financial risk and operational aspects within APMs.
• To identify potential improvements for future physician-led payment reforms.

Main Methods:

• Qualitative systematic review of 24 physician-focused payment model proposals submitted to CMS.
• Assessment of models based on 10 key dimensions.
• Evaluation of underlying themes across proposals.

Main Results:

• Key features identified include willingness to bear financial risk, emphasis on case management, adoption of new technologies, and consideration of legal barriers.
• Analysis provides insights into provider priorities and expectations for APMs.
• Specialists are actively engaging in designing payment models.

Conclusions:

• Specialists are poised to lead in the evolving healthcare payment landscape.
• Recommendations are provided to enhance physician-designed APMs.
• Findings offer valuable guidance for payers and policymakers on provider-preferred payment reforms for value-based care.