As with all APMs, P-COAT would be what is called a “ two-sided risk model” where physicians would have to meet certain quality measures to qualify for bonus payments and would be penalized if they did not. Selection of appropriate measures still is being worked out and is something on which the organizations are seeking comment.
“Unfortunately, we do not have a strong set of known quality outcomes that have been appropriately vetted across the past 10 years,” said Dr. Ryan, president and chief medical officer of BrightView, an outpatient addiction medicine practice in Cincinnati. “ASAM is working on those quality outcomes parameters. As those become more codified, we put them into the model.”
At press time, there was no timeline for when P-COAT might be implemented, but ASAM is pushing to move this into practice sooner rather than later.
“I will be disappointed if we wrote a philosophy paper,” Dr. Ryan said. “That was not my goal. It is my hope that this will result in an increase of quality and quantity of delivery for opioid use disorder and providers better reimbursement to providers and more access for the payers and the members and the patients.”
AMA and ASAM are working with private payers to find an organization to pilot the alternative payment model. ASAM also said that it was in talks with the Centers for Medicare & Medicaid Services to see how to include it in federal health care programs.