The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM).
As documented by Starfield and others, health care systems based on primary care have healthier populations, greater equity, and lower cost. However, current quality measures do not reflect most of the mechanisms hypothesized to provide this value. Incorrectly focused measurement and incentives risk burning out the workforce and diminishing the value of primary care for people and populations.
The Comprehensive Primary Care Payment (CPCP) model was developed from a research study by Family Medicine for America’s Health to examine the efficacy, challenges, and successes of value-based primary care payment models currently in use in the U.S. The resulting recommendations provide a framework and justification for critical components of a CPCP model. This methodology applies these recommendations by calculating a payment rate that is driven by current fee-for-service payment history and then applying 4 modifiers.
The objective of this project is to research and develop a quantitative methodology to describe a comprehensive primary care payment model and create a prospective calculator which applies this methodology and models its expected impact. This study surveys the current state of value-based primary care payment models in use in the U.S. and draws key information about the efficacy, challenges, and successes of these programs. The resulting recommendations provide a framework and justification for critical components of a CPCP model.
Comprehensive Primary Care Payment (CPCP) is a fixed, periodic payment for services delivered over a period of time. This is an up-front comprehensive payment to provide high-quality and high-value primary care services to a patient population. CPCP is adjusted for chronic disease burden, social determinants of health, quality and utilization.
In the United States, primary care is under strain due to lower compensation for primary care providers, payment and delivery system models that motivate high volumes of patient visits, and a shortage of providers. Simultaneously, there is a heightened national awareness of the central role of primary care in improving population health and managing cost growth.
Primary care investment should be tracked and reported through a standardized measure. Long-term, systemic change demands a system that ensures a standardized measurement at the health plan level across all payers to track and publicly report primary care investment. This data is essential to demonstrate that increases in investment lead to improved quality.
States are leading the way when it comes to prioritizing advanced primary care through increased spending or measurement designed to encourage increased spending. A variety of PCPCC members and partners are engaged at both the state and federal levels. Please find below a brief update on some of the most exciting examples of state leadership.
Objectives: The Pennsylvania Chronic Care Initiative (CCI) was a statewide patient-centered medical home (PCMH) initiative implemented from 2008 to 2011. This study examined whether the CCI affected utilization and costs for HIV-positive Medicaid patients with both medical and behavioral health comorbidities.
