Patient-Centered Payment for Primary Care

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 payment for each patient is based on the services that patient needs and wants to receive;
  • The payment for each patient ensures that patient receives high-quality care in the most efficient way;
  • The payment amounts are adequate to support the cost of delivering services to each patient in a high-quality manner;
  • The payments are affordable for patients with and without insurance.

The report provides a complete design for a Patient-Centered Primary Care Payment system, including all of the details needed for implementation, such as:

  • The types of payments a primary care practice would receive for each of the major categories of services it delivers;
  • How existing practice billing systems and health plan claims payment systems can be used to pay primary practices in a better way;
  • The dollar amounts for each payment that will provide adequate revenues to support high-quality care to patients with different needs; and
  • How patients and purchasers would be assured that each patient is receiving appropriate, high-quality services.

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: