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Delivery and Payment Models

The Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have led to the development of new health care delivery and payment systems that are intended to improve outcomes, decrease cost, and restructure reimbursements, moving from traditional fee-for-service to value-based care. This page provides more in-depth information to help understand some of the major models that have emerged in recent years.

Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) to transition physicians away from a volume-based system toward one that rewards value. This information can help in understanding how to succeed in MIPS and APMs and other quality performance and value-based programs.

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Patient-Centered Medical Home

The Patient Centered Medical Home is a care delivery model that optimizes high quality, coordinated, patient-centered care facilitated by teamwork, good communication, information technology, and efficient processes to assure that patients get the indicated care when and where they need it.

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Direct Patient Contracting

A direct patient contracting model is one in which a patient contracts directly with a physician, clinician, or practice to pay directly out-of-pocket for some or all medical services that are provided by the clinician or practice. Direct patient contracting models include a number of different arrangements including direct primary care and concierge care.

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Evaluating Payment Contracts

AMA and RAND created two resources to help physician practices when evaluating bundled or episode-based and pay-for-performance agreements. (Note: Accessing these resources may require registration on the AMA site.)

Evaluating Pay-for-Performance Contracts

Evaluating Bundled or Episode-Based Contracts