Spotlight on Primary Care Payment Model Work Group

Q&A with Bill Golden and Susan Edgman-Levitan, Chairs of Primary Care Payment Model Work Group

Many thanks to everyone who submitted nominations and referrals for the new Primary Care Payment Model (PCPM) Work Group. We received over 130 nominations and appreciate the high level of engagement and enthusiasm for this work. We recently sat down with Work Group chairs, Bill Golden and Susan Edgman-Levitan, to get their views on the group’s charge:

Edgman-Levitan: New payment models can help reduce the stress on primary care providers, which is driven, in part, by our current productivity-based payment model. Clinician burnout is a huge issue and will create more access issues for patients if we don’t create payment systems that support practice transformation solutions, patient engagement strategies, and teamwork and coordination across the continuum of care.

Golden: The current financing of primary care can limit innovation and promote professional dissatisfaction because of overhead concerns that drives high volume, acute care visits. Payment reform can shift incentives to reward success in patient centered, coordinated chronic care management and provision of preventive services. Breaking away from current fee for service formats could revitalize primary care and result in a more sustainable health care system.

Golden: There is a timely opportunity to redesign primary care payment and increase patient-centered care, improve professional satisfaction of doctors and nurses, and bend the cost curve of the American health care system.

Edgman-Levitan: I am committed to revitalzing and redesigning our system of primary care to support our clinicians, staff, patients and families in their pursuit of good health. I believe that new payment models can help foster this and have never seen sucn alignment for this on the part of cms, other payers, clinicians and the public. I also am excited about the opportunity to work with dr. Golden who has been such a leader in this work.

Golden: We will review the impact of current payment structures on limiting patient-centered care and innovation in primary care. From there, we can design principles of reimbursement that can lead to a better future.

Edgman-Levitan: In addition to that, I hope we can do an environmental scan of new payment models in action that we might advance more broadly.

Golden: The LAN is a large, engaged community of diverse stakeholders who understand the need to restructure payment to reward health system stewardship. The opportunity for widespread dissemination of the Work Group white paper online, through webinars, and at national summit meetings will result in extensive discussion and proactive suggestions for improvement. I am optimistic that the LAN process will produce an effective roadmap for adoption and adaption by delivery systems throughout our communities.

Edgman-Levitan: The LAN participants can be helpful as a “test bed” to pilot new payment models and evaluate their impact. Feedback from diverse participants will also be helpful to create a consensus to move forward with this important work.

To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume. The Health Care Payment Learning and Action Network (LAN) was established as a collaborative network of public and private stakeholders, including health plans, providers, patients, employers, consumers, states, federal agencies, and other partners within the health care community.