High-quality primary care is an essential component of a high-value healthcare system. Unfortunately, the fee-for-service payment systems currently used by Medicare and most health insurance plans do not support high-quality primary care. Moreover, none of the approaches that have been used or proposed as alternatives to standard fee-for-service payments - including pay-for-performance, medical home payments, and population-based payments - solves these problems, and some can make it even less likely that patients will receive high-quality care.
Patient-Centered Payment for Primary Care describes a better way to pay for primary care, in which:
The report provides a complete design for a Patient-Centered Primary Care Payment system, including all of the details needed for implementation, such as:
In addition to the full report and a video, an Executive Summary, a 2-page description of the payment structure and implementation plan, and an FAQ document are available.
Although many chronic conditions can be managed effectively by a primary care practice (if the practice is paid adequately to do so), some patients with a chronic condition will need services from a specialist for diagnosis, development of a care plan, and/or treatment and care management. This is particularly true for patients who have difficult-to-diagnose symptoms and severe, complex, or uncommon conditions.
In order to ensure that all patients can receive the most effective care, specialists who diagnose and treat chronic conditions need to receive adequate and appropriate payments for their services. In a patient-centered payment system for care of chronic conditions:
Patient-Centered Payment for Care of Chronic Conditions explains how to create a patient-centered payment system that solves the problems with both fee-for-service payments and current value-based payment systems. The report provides all of the details needed for rapid implementation, including: