Risk Resources

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 it right.

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, and revenue-sharing.
  • 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 costs down.
  • MACRA: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), repealed the Sustainable Growth Rate (SGR) payment system and its fee-for-service (FFS) reimbursement model, with a new two-track system that requires physicians and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.