Gainsharing – Key Component to an Effective Population Health Strategy.

Performance based incentives are at the heart of health reform.  ACOs cannot succeed unless their internal financial incentives are fully aligned, based on performance. One the purest forms of performance based incentives is gainsharing, the direct payment by hospitals to physicians, based on performance. 

Gainsharing can provide a fundamental building block for emerging ACOs by implementing a strong catalyst for culture change.  Also important, gainsharing can be implemented quickly, providing a kick start to organizations struggling with tight timelines. As the inpatient module to any health reform initiative, gainsharing improves efficiency and quality with a demonstrated program of performance based incentives. Implemented, its impact can be expanded to other areas of operation.

Healthcare professionals understand the relationship between doctors and hospitals is the nucleus of health reform.  Existing relationships between physicians and hospitals often compromise the potential of ACOs. The methodology’s design, objectivity and fairness allow providers to overcome historical barriers to collaboration. Since AMS introduced AMS PBIS® in 2006, hospital-physician alignment not only has provided financial benefit for hospitals and physicians, but also is viewed as a tool to improve quality scores on targeted initiatives and to improve coordination of care efforts that can help to reduce readmissions.  The program integrates smoothly into broader population health initiatives.

AMS PBIS® success is based in experience and practicality. Through 10+ years of development of AMS PBIS®, AMS established a successful program comprising multiple, interwoven practices: setting institutional priorities based on impact; communicating proposed solutions to the physicians; and paying for results.  It can be implemented quickly. Hospitals and physicians typically see results within the first year of implementation – in many cases well before the ACO structure is fully organized.

AMS Gainsharing. Proven Business Model. Measurable Results.

It is practical to implement. The AMS Gainsharing Program stands alone or can be integrated into other hospital quality improvement initiatives and physician alignment strategies. It has demonstrated the potential to support significant, positive change. AMS serves as an independent scorekeeper. This role is important for satisfying legal and regulatory concerns. We found because of its careful balance and objectivity, it adds to hospital credibility to efforts aimed at engaging physicians. The AMS Gainsharing Program allows hospitals to implement strategic and operational initiatives aligning hospital and physician incentives — ultimately driving performance improvements.

AMS’ ability to integrate with new and existing hospital programs to maintain or improve quality of care while reducing costs distinguishes it from alternatives.

AMS PBIS®. The Leading Methodology Driving Performance Improvement. Developed by Industry Leaders.

AMS PBIS®, the core of the AMS Gainsharing Program, provides a comprehensive gainsharing methodology. Approved by CMS in large scale Medicare Bundled Payment for Care Improvement (BPCI) initiatives, specifically Model 1, it is also the solution used in commercial gainsharing and quality improvement programs.

AMS PBIS® provides rewards for efficient performance and for improvement through its bonus-only plan. Incentives offset any potential loss of physician professional income, especially those resulting from reductions in length of stay. Features such as these were designed into the AMS PBIS® specifically to secure physician buy-in. Organizations cannot succeed without effective collaboration between physicians and the ACO.

AMS PBIS® represents over a decade of product development. Designed and led by a team of industry experts soliciting input and directly addressing issues presented by three parties: regulators, physicians and hospitals.