Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care

High-quality primary care is the foundation of a high-functioning health care system. When it is high-quality, primary care provides continuous, personcentered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.

Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country’s primary care services a public concern.

The National Academies of Sciences, Engineering, and Medicine formed the Committee on Implementing High-Quality Primary Care in 2019. Building on the recommendations of the 1996 Institute of Medicine report Primary Care: America’s Health in a New Era, the committee was tasked to develop an implementation plan for high-quality primary care in the United States.

The committee’s definition of high-quality primary care (see Box 1) describes what it should be, not what most people in the United States experience today. To rebuild a strong foundation for the U.S. health care system, the committee’s implementation plan includes objectives and actions targeting primary care stakeholders and balancing national needs for scalable solutions while allowing for adaptations to meet local needs.

The committee set five implementation objectives to make high-quality primary care available to all people living in the United States:

1. Pay for primary care teams to care for people, not doctors to deliver services.

2.Ensure that high-quality primary care is available to every individual and family in every community.

3.Train primary care teams where people live and work.

4.Design information technology that serves the patient, family, and the interprofessional care team.

5.Ensure that high-quality primary care is implemented in the United States.

Author/s:

The National Academy of Sciences

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Brian Desmarais — Mon, 01 Jul 2019 14:40:44 +0000

Date Added:

July 1, 2019

Journal/Publication:

Health Affairs Blog

Publisher:

Health Affairs

Publication Date:

June 28, 2019

URL:

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

Centers for Medicare and Medicaid Services (U.S.)

Social Responsibility

Quality of Health Care

Medicare is about to roll out something they are calling Direct Primary Care, which is not at the same thing as the Direct Primary Care concept that evolved as a form of “concierge medicine” in which patients pay a monthly fee for increased access and services from primary care clinicians. This is something with which I believe all primary care clinicians need to become familiar. James W. Mold, MD, MPH

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Direct provider contracting (DPC) is coming to Medicare.

Under a new announcement about reforming health care payment and delivery, the Centers for Medicare and Medicaid Services (CMS) has announced forthcoming DPC models as part of the effort to “deliver value-based transformation in primary care.” In particular, the agency seeks to implement models that enable it to directly contract with providers and suppliers and hold them accountable for the cost and quality of care of defined patient populations. Direct contracting shares and extends some features of existing primary care payment reforms, such as an emphasis on financial accountability over outcomes. However, DPC differs from existing primary care payment models primarily by allowing Medicare to contract with providers for a population of beneficiaries’ entire health care spending via global capitated payments. This incorporates approaches from Medicare Advantage (through which Medicare contracts with health plans for beneficiaries’ entire health care spending), while adding flexibility and emphasis on beneficiary choice.

Author/s:

Liao, J.M., Navathe, A.S.