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To enable medical practices to support a different model of care delivery, the PCMH model realigns compensation incentives to promote the value of care delivered, rather than the volume of care. In Colorado, the Multi-Payer, Multi-State PCMH Pilot is testing a “blended" payment model. Participating payers compensate pilot practices with a combination of standard fee-for-service payment, a monthly care-management fee and a bonus for meeting or exceeding quality outcomes. Theoretically, blended payment will shift the focus of care delivery away from episodic care and toward a more comprehensive approach that recognizes preventive and chronic-care services. Blended payment, combined with a whole-person approach to care, encourages lower costs and better outcomes.
During the course of deliberations with insurers and medical practices when we established the PCMH Pilot, HealthTeamWorks acquired considerable knowledge about Federal Trade Commission antitrust issues, patient attribution challenges, the impact of administrative-service-only self-insured employers, and the balance between what practices need to provide enhanced care and what insurers are willing to pay. Prompted by these experiences, HealthTeamWorks has actively participated in the Patient-Centered Primary Care Collaborative Payment Reform Task Force.
Along with practice transformation services, HealthTeamWorks can help build strong coalitions in support of healthcare payment reform. This represents one more area of expertise that we can bring to practice aggregators as they attempt to align financial incentives to produce high-quality healthcare delivery at lower cost.
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