August 2, 2016 – eNewsletter

The recommendations highlight both design and operational considerations and offer a high-level roadmap for these models while leaving enough flexibility to allow for the implementation of models that are tailored to local markets. Ultimately, the paper addresses how CEP models can position patients and consumers – their clinical needs, values, and preferences – at the center of the health care system.

• Using “big dot” outcome measures in performance measurement
• That organization-specific benchmarks quickly converge on regional benchmarks
• The gold standard is patient choice in patient attribution
• Data should follow the patient, and population-level aggregate data should be a public good in data sharing

The PBP suite also provides the foundation for the new work of the Primary Care Payment Model (PCPM) Work Group that kicked off last month.

Patrick Gordon, associate vice president of community integration for Rocky Mountain Health Plans, provided an overview of the PAC, offering a vision that will give payers and other stakeholders the opportunity to discuss challenges and solutions that are an inherent part of designing and implementing sustainable APMs in the primary care setting.

Deidre Gifford, director of state policy and programs at the National Association of Medicaid Directors, discussed the MAC, saying that the objective will be to support and facilitate the adoption of maternity care episode payment.

More information will be provided on the LAN website as the Collaboratives are established. If you would like more information on either the MAC or the PAC, please contact the Action Collaboratives Lead Tanya Alteras, talteras@mitre.org.

Co-chaired by Bill Golden, Guiding Committee member and medical director of Arkansas DHS/Medicaid, and Susan Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, the 22 member Work Group quickly focused on what a set of foundational principles should include.

The wide-ranging discussion explored the current challenges, multitude of settings, and opportunities that Comprehensive Primary Care Plus (CPC+) and new private sector models pose. The prevailing sense of the group is that preventative services are underutilized, leading to greater incidence of precursors for chronic disease; that patients are referred to specialists for procedures and services that do not provide much value; and that consistent high quality health outcomes are lacking for the amount of resources consumed.

The group discussed initial ideas for principles to guide the development of their recommendations on primary care payment models. Some of the suggestions included the idea that payment should support the delivery of primary care by teams of health professionals and promote the integration of care and community resources.

To help inform these principles and recommendations, the Work Group would like input on the following initial question: What is your experience (or challenge) with payment for care in alternative settings outside the primary care physician’s office (such as virtual visits, phone consultations, retail clinics, employer-based clinics, etc.)? Please respond to hcplan-pcpm@mitre.org with your thoughts by Monday, August 15.

While many evaluations may not be public yet, the Hub would like to learn of any that your organization has completed and about payment initiatives that have not been evaluated (past, present, or future). Contact the Hub if interested in getting an evaluation for an upcoming payment initiative. The Hub can supply evaluation expertise and help with understanding the impact of the initiative (including what factors are necessary for success).

If interested, fill out this survey to let the PRE Hub know the basics about your payment reform initiative, and they will follow up with you to learn more. If you have questions, please contact Rob Saunders at robert.saunders@duke.edu.