Nonprofits take steps to reform primary care delivery, payment
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The Primary Care Collaborative and other nonprofit organizations are taking action to help remove barriers to reforming primary care delivery and payment, according to a presentation at the Primary Care Collaborative’s virtual meeting.
For years, the Primary Care Collaborative (PCC) has been working with stakeholders to help transition practices to advanced primary care models that focus on quality. Previously, the PCC partnered with more than 100 organizations to develop seven characteristics that illustrate “the ideal vision of primary care.”
These characteristics, known as the “Shared Principles of Primary Care,” include:
- person- and family-centered care;
- continuous care;
- comprehensive and equitable care;
- team-based and collaborative care;
- coordinated and integrated care;
- accessible care; and
- high-value care.
To date, more than 350 organizations have adopted the Shared Principles, according to Ann Greiner, president and CEO of the PCC. However, primary care physicians need additional support from payers and purchases to receive the resources they need to implement these principles into practice.
The PCC recently worked with two employer groups — the National Alliance of Healthcare Purchaser Coalitions (National Alliance) and the Pacific Business Group on Health (PBGH) — to identify ideal attributes of primary care among health care purchasers. Elizabeth Mitchell, president and CEO of PBGH, said the attributes identified by members of her organization — which include large employers such as American Airlines, Boeing, Intel and Comcast— closely align with the Shared Principles.
“All of the principles that the PCC has endorsed and promoted over the last several years actually line up perfectly with what employers want to see with the health care system,” Mitchell said during the presentation. “Employers and primary care providers want the same thing. We need to have direct conversations so that we better understand that.”
The employer-identified attributes of primary care include:
- enhanced access;
- optimized time with patients;
- realigned payment methods;
- organizational and infrastructure backbone;
- disciplined focus on whole-person health;
- behavioral health integration; and
- referral and care management.
According to Greiner, these attributes will be “critical to turning our vision for advanced primary care into reality.”
The next steps will be to use these attributes to develop a set of patient-reported outcome measures that demonstrate the value of advanced primary care and, in turn, help reform payment, Mitchell said. PBGH’s California Quality Collaborative is currently developing these outcome measures.
“There is a very practical need to show the outcomes so that we can partner effectively,” she said.
One example of an outcome measure is depression remission. Mitchell said PBGH and its partners are looking into whether behavioral health integration can do more than just screen patients for depression, but also help them achieve remission.
“We are working with purchasers and providers to pilot these outcome measures,” she said. “Our members want to pay differently, but they’ve got to see those outcomes to know how to do that.”
PBGH is also developing a national payment reform workgroup to help facilitate change among health plans.
“I believe there are a lot of health plan leaders who want to change primary care payment,” Mitchell said. “Frankly, employers can’t do this without health plan partnership. In our primary care payment reform workgroup, what we would like to do is get alignment among employers to share that alignment with the plans. Hopefully, that will translate across payment platforms for providers.”
Greiner said the Alliance for Community Health Plans (ACHP), an organization representing 24 nonprofit health plans in the United States, is facilitating payment reform by urging its members to increase primary care spending, which is currently estimated to be only 5 to 7 cents of every health care dollar.
“I want to call out ACHP for their leadership and invite more health plans to put this kind of policy in place,” Greiner said. “The PCC stands at the ready to work with all payers and employers who are ready to embrace a comprehensive payment for a comprehensive set of primary care services.”
References:
Mitchell E. Call to Action: Purchasers Seeking Primary Care Payment & Delivery Reform. PCC Annual Conference; Nov. 30 – Dec. 1, 2020 (virtual meeting).
Primary Care Collaborative. PCC, National Alliance of Healthcare Purchaser Coalitions and Pacific Business Group on Health announce new attributes of advanced primary care. https://www.pcpcc.org/2020/11/24/pcc-national-alliance-healthcare-purchaser-coalitions-and-pacific-business-group-health. Accessed Dec. 1, 2020.
Primary Care Collaborative. The Shared Principles of Primary Care: A multistakeholder initiative to find a common voice. https://www.pcpcc.org/2019/02/27/shared-principles-primary-care-multistakeholder-initiative-find-common-voice. Accessed Dec. 1, 2020.