Accelerating the adoption of value-based care

The shift to value-based care (VBC) is happening rapidly. Whether through innovative new team-based care models or more traditional Accountable Care Organizations (ACO) relationships, patient care focused on value is reshaping current medical practice. Current Procedural Terminology (CPT®) codes provide a foundation to support the success of VBC models. These insights were identified through landmark research conducted by the AMA, in collaboration with Manatt Health, to understand the CPT code set’s role in VBC.

This research, coupled with AMA-developed educational content, best practices (PDF) and playbooks (PDF) for physicians, creates a suite of content that provides greater context to the nation’s understanding of VBC models and helps physicians broadly adopt innovative VBC models.

The goal of this research is to understand how the CPT code set supports current VBC arrangements and opportunities for continued evolution. The AMA interviewed more than 40 individuals across 34 organizations representing VBC provider organizations, health plans, integrated delivery systems, VBC enablement organizations, health technology organizations and others. 

This issue brief synthesizes vital feedback from each sector of the health care ecosystem and identifies three areas in which CPT codes are successfully enabling VBC adoption.   

Respondents identified several ways in which the CPT code set enables value-based care payment models.

• The CPT code set drives the identification of patients for targeted clinical intervention and supports payer quality improvement efforts.
• The CPT code set supports spend benchmarking, risk adjustment and budgeting. It enables the identification of high-cost events and high-cost patient cohorts. The code set also enables provider network management.
• CPT is foundational for patient attribution. It enables innovative digitally enabled care bundles and facilitates contracting between companies offering digitally enabled care and payers.

The stakeholders interviewed also shared ideas for evolving the CPT code set to accelerate adoption of VBC delivery:

• Evolving CPT codes to reflect new types of practitioners delivering health care services.
• Supporting new care delivery models with bundled service codes.
• Considering how CPT might address new types of health care services.

The AMA and the CPT Editorial Panel are committed to progressing the code set to ensure it continues to evolve in ways that support the delivery of high-value care to patients and meets the needs of physicians, health professionals, health systems, policymakers and payers.

Convened by the AMA, the independent CPT Editorial Panel is entrusted with the task of maintaining the CPT code set by revising, updating or modifying CPT codes, descriptors, rules and guidelines. Learn more about the CPT Editorial Panel.

Anyone can submit an application for a CPT code. Find out how to submit a CPT code change application via the CPT Smart App.

CPT Editorial Panel meetings are held three times a year, virtually and in-person at different locations across the United States. Attend the next CPT Editorial Panel meeting.

Leadership opportunities are posted when there are openings on the CPT Editorial Panel, the CPT Advisory Committee, and/or the CPT Assistant Editorial Board. Check for CPT nominations and opportunities.