AMA Backs Team-Based Care Delivery, Value-Based Drug Pricing

November 16, 2016 - The American Medical Association (AMA) recently released updated organization-wide ethical guidelines that detailed how organizations can lower healthcare costs using team-based care delivery as well as how the industry can implement value-based drug pricing.

Under value-based reimbursement models, care delivery must demonstrate enhanced care coordination and quality improvement to maximize claims reimbursement revenue. The AMA suggested that healthcare organizations implement physician-led team-based care to effectively provide coordinated, high-quality care in the most cost-effective manner.

“Physician-led collaborative care has been proven time and again as an effective, consultative approach to providing high-quality medical care,” said Kevin W. Williams, AMA Board Member. “An effective team requires vision and direction of an effective leader and physicians are uniquely suited to serve as a clinical leader who will ensure that the team as a whole functions effectively and facilitates patient-centered decision-making.”

Team-based care should be spearheaded by a physician because they have “thorough and diverse training, experience and knowledge” as well as “a distinct appreciation of the breadth of health issues and treatment options that enable them to integrate the diverse professional perspectives and recommendations of the team into an appropriate, coherent plan of care for the patient.”

Healthcare organizations should select physicians that can model leadership in the following ways:

• Understand the breadth of their own and other team member’s skills, expertise, and roles in patient care

• Clearly voice responsibilities and accountability

• Promote ideas from other team members in an open manner

• Master comprehensive teamwork skills, including encouraging core team values, promoting open discussion of ethical and clinical concerns, fostering an open and honest team culture, communicating provider roles in the team, and using transparent decision-making

The AMA also stated that physician leaders should advocate for team support and resources that will help the group to more effectively provide high-quality care. Physician leaders should also encourage their organizations to address care coordination and provider collaboration barriers through institutional policies and procedures.

The healthcare industry group also added the updated team-based care delivery guidelines to the AMA’s Code of Medical Ethics, which was recently updated after eight years.

Additionally, the AMA released a statement supporting value-based prescription drug pricing as another effective way to lower healthcare costs for providers and patients. At the Interim Meeting of the AMA, physicians supported aligning drug prices with patient outcomes and cost.

“The new AMA policy acknowledges the carte blanche approach to drug pricing needs to change to align with the health system’s drive for high-quality care based on value,” stated Andrew W. Gurman, MD, AMA President. “This transformation should support drug prices based on overall benefit to patients compared to alternatives for treating the same condition. We need to have the full picture to assess a drug’s true value to patients and the health care system.”

In light of rising prescription drug rates, the AMA called on public and private payers to implement the following:

• Use independent organizations to determine value-based drug prices

• Determine value-based prescription drug rates using reliable and accurate data, such as clinical trials, clinical data registries, comparative effectiveness studies, and comprehensive short- and long-term outcome measures

• Establish transparent value-based pricing processes that can be easily accessed by physicians and patients

• Develop processes that limit administrative burdens on physicians and patients

• Create value-based pricing strategies that include affordability criteria to ensure patient affordability

• Allow for patient variation and physician discretion when pricing prescription drugs

The AMA also stated that prescription drug rates should account for a drug’s “public health value.” The organization expressed support for direct purchasing of drugs used to treat or cure conditions that pose a public health threat, such as hepatitis C.

Direct purchase arrangements would ensure affordable prescription drug rates and volume for manufacturers, the AMA claimed.

“The AMA principles emphasize that efforts to price prescription drugs based on value should ultimately benefit patients and the health care system without stifling innovation in the pharmaceutical industry,” added Gurman. “These initiatives should aim to ensure patient access to necessary prescription drugs and allow for patient variation and physician discretion.”

Dig Deeper:

• Preparing the Healthcare Revenue Cycle for Value-Based Care

• Why Healthcare Needs Value-Based Supply Chain Management