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Tip of the week: Approach the AMH like a gatekeeper

Managed Care Weekly Advisor, April 18, 2007

For the time being, to those who actually structure and negotiate contracts between payers and providers, the Advanced Medical Home (AMH) concept, also known as patient-centered care, looks and feels like a traditional gatekeeper model and probably should be approached on that basis.

Unlike capitation, the AMH model doesn't entail a complete shift of risk to physicians and doesn't necessarily require experience with risk-based contracting. Nevertheless, physicians should expect to see language in their contracts obligating them to report quality and, perhaps, outcomes data to receive the performance-based component of the payment.

Anticipating the range of care coordination activities that might be included in a contract based on the AMH concept and assessing the adequacy of proposed management fees for these activities is a dicier proposition. Practices that haven't done actuarial work or risk contracting won't have sufficient comparative data to measure up against payers.