Article Figures & Data
Tables
- Table 1
Comprehensive Primary Care Services Expected by Medicare Fee-for-Service Beneficiaries for Innovation Center Enhanced Payment Eligibility
Primary Care Functions Description 1. Risk-stratified care management Patients with serious or multiple medical conditions need more support to ensure they are getting the medical care and/or medications they need. Participating primary care practices will deliver intensive care management for these patients with high needs. By engaging patients, primary care clinicians can create a plan of care that uniquely fits each patient’s individual circumstances and values 2. Ensure access to and continuity of care Because health care needs and emergencies are not restricted to office operating hours, primary care practices must be accessible to patients 24/7 and be able to utilize patient data tools to give real-time, personal health care information to patients in need. Patients are best served when they receive their care from the same clinician or health team with whom they build a trusted relationship 3. Deliver planned care for chronic conditions and preventive care Primary care practices will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care. With disease registry capacity, practices can better track their chronically ill patients and provide the full range of timely and appropriate health services 4. Engage patients and caregivers Primary care practices will have the ability to engage patients and their families in active participation in goal setting and decision making. Through a variety of policies and tools, patients can be full partners in truly patient-centered care 5. Coordinate care across the medical neighborhood Primary care is the first point of contact for many patients and takes the lead in coordinating care as the center of patients’ experiences with medical care. Under this initiative, primary care physicians and nurses will work together and with a patient’s other health care clinicians and the patient to make decisions as a team. Access to and meaningful use of electronic health records should be used to support these efforts
Additional Files
The Article in Brief
New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS
Richard J. Baron
Background The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the 2010 Patient Protection and Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. This report highlights some of the Center's new primary care programs and initiatives.
What This Study Found The Innovation Center is testing new payment and service delivery models, relying on collaboration among multiple stakeholders in the interest of better, more affordable patient care. Specific initiatives include a Multi-Payer Advanced Primary Care demonstration, a Federally Qualified Health Center demonstration, and a Comprehensive Primary Care initiative testing whether larger, strategic investment in primary care will lead to improved health at lower overall costs.
Implications
- By changing delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, the United States may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide.
