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11 Strategies for Payment Reform in Primary Care

Joe Cantlupe, for HealthLeaders Media, March 31, 2010

Reforming payment structures for primary care "is absolutely essential to the implementation and sustained operation" of a medical home, according to the chairman of a payment reform task force for the Patient-Centered Primary Care Collaborative.

Allan H. Goroll, MD, professor of medicine at Harvard Medical School and PCPCC task force chairman, says payment reform is essential to sustain operation of the patient-centered medical home (PCMH), and a "blended strategy" may help minimize shortcomings of any single payment method. However, any reform would face considerable resistance because of fears of the unknown, Goroll says.

Goroll made his comments Tuesday during a meeting of the PCPPC held in Washington, DC, in which the medical home programs were touted. The PCPCC released a white paper that called for value-based insurance design (VBID) and the patent centered medical home (PCMH) to improve healthcare delivery.

The two health plan initiatives should be incorporated to help reduce costs, according to the PCPPC report's authors, who contend that "obvious synergies" between the two programs often go unnoticed because they are carried out separately.

"Although some medical home projects have gotten launched because you have dedicated physicians, and other healthcare providers, wonderful teams of ordinary people doing extraordinary things, their work is not sustainable nor is that model implementable on a wide-scale to others," Goroll says.

The task force is expected to issue a report soon for which he based his remarks on Tuesday, Goroll adds.

"The real question we face now is not that we can get the vanguard launched, but what is it going to take to move this from an interesting project to really transforming primary care in the US and hopefully healthcare?" Goroll says. "That's the backdrop of our payment reform task force."

PCPCC is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, and clinicians who have joined together to develop and advance the patient-centered medical home. That is an approach to providing comprehensive primary care in a healthcare setting that facilitates partnerships between patients, their personal physician, and when appropriate, the patient's family.

VBID is an employer-driven design strategy to optimize use of higher value healthcare services and reduce use of lower value services. The PCMH is a supply-side mechanism to enable clinicians to delivery better quality care more efficiently, according to the report.

Goroll says a transition to a "new system can be challenging."

"Despite the promise of a much improved payment mechanism, payment reform will face considerable resistance—stakeholders have figured out the rules of the old system and change entails unknown risks," Goroll says.

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