As chair of Family Medicine for America's Health Payment Tactic Core Team, we have been working to develop a payment model and structure for Comprehensive Payment for Primary Care. Comprehensive Primary Care Payment (CPCP) is a monthly up-front comprehensive payment for a defined package of services which provide high-quality and high-value primary care to a patient population. This payment gives doctors the freedom to deliver the care that best meets the needs of their patients. Comprehensive primary care payment is adjusted for chronic disease burden, social determinants of health, quality and utilization. This payment model encourages doctors to focus on health outcomes rather than the volume of visits or tests. Services are accessible, responsive to an individual’s preference, and patients can take advantage of enhanced in-person hours and 24/7 telephone or electronic access. Patients at highest risk receive proactive, relationship-based care management services to improve outcomes through payment for a package of primary care services rather than individual components of services. Care is comprehensive, and practices can meet the majority of each individual’s preventive, physical and mental health care needs. Care is coordinated across the health care system, including specialty care and community services; and patients receive timely follow-up after emergency room or hospital visits. Care is patient-centered, recognizing that patients and family members are core members of the care team. The team actively engages patients to design care that best meets their needs. Quality and utilization of services are measured, and data is analyzed to identify opportunities for improvements in care and to develop new capabilities. Comprehensive payment is tied in part to achievement of the principles of the Triple Aim (better population health, better patient experience, and lower costs). Comprehensive payment needs to be sufficient to allow primary care practices to adapt to the needs of their local communities and invest sufficiently in their operations to find innovative ways of delivering health care to their patients and communities. Comprehensive payment is not based on the valuation of the RBRVS fee schedule.
Thomas Weida