Family Medicine for America's Health

Payment Tactic Team

Payment Tactic Team

The Payment Team has been charged with achieving one of the major objectives in family medicine’s specialty-wide strategic plan:

“In order to give patients the comprehensive and coordinated care and attention they deserve, family medicine commits to moving primary care reimbursement away from fee-for-service and toward comprehensive primary care payment (CPCP)as quickly as possible in coordination with its primary care colleagues.” (FMAHealth Strategic Plan, 2014)

To achieve this objective, the Payment Team has been working on a number of projects. Two of them are featured here:

  • A comprehensive primary care payment calculator. The CPCP Calculator can be used by practices, employers and payers to provide an example of how a comprehensive primary care payment could be structured.
  • Development of the Primary Care Innovators Network, whose partners are working with self-insured hospitals, health systems and interested practices to introduce a CPCP framework to provide primary care services to their employees.

Many practices are already working in a comprehensive payment framework. Rebecca Malouin and her team have been learning how they do it. Work on that project will be completed later in 2017.

Core Team Members

Thomas J. Weida, MD (team leader); Associate Dean of Clinical Affairs, CMO, and Professor, University of Alabama College of Community Health Sciences

Stanley Borg, DO; Principal, Borg Associates

Steven Kamajian, DO; President & CMO, Westminster Community Health Center and Westminster Free Clinic

Rebecca Malouin, MS, MPH, PhD; Assistant Professor, Michigan State University

Karen Smith, MD; Family Physician/Owner

Karen L. Smith, MD, FAAFP

Erika Bliss, MD (Advisor); CEO, Qliance Management Inc.

Paul Martin, DO, FACOFP (FMAHealth Board Liaison); CMO, Kettering Health Network

Additional Project Team Members/Advisors

Bruce Bagley, MD

Margaret Day, MD

Aaron George, DO

Matthew Harker, MBA, MPH

Kathryn Harmes, MD

Neha Sachdev, MD

*Working Definition of Comprehensive Primary Care Payment (CPCP)

Comprehensive Primary Care Payment (CPCP) is a fixed, periodic payment for services delivered over a period of time. It is an up-front comprehensive payment to provide high-quality and high-value primary care services to a patient population. CPCP is adjusted for chronic disease burden, social determinants of health, quality and utilization.

Comprehensive primary care payment is designed to offer physicians and their teams the freedom to do what they do best: Deliver the care that best meets the needs of their patients. CPCP stands in contrast to the Fee-For-Service (FFS) system that limits care to face-to-face visits and is driven by the documentation requirements to support billing of an office visit. The CPCP payment model incentivizes doctors to focus on health outcomes rather than the volume of visits or tests.

 

Comprehensive Primary Care Payment adjusts payment to address the complexity of the patient population by meeting defined quality measurers, efficiency and necessary infrastructure investments to achieve practice transformation

For a working definition of Comprehensive Primary Care Payment see (downloadable pdf)

CPCP Calculator- Translating the Idea into Practice

The Comprehensive Primary Care Payment Calculator project team, led by Stanley Borg, D.O. developed a tool designed to create specific examples for both practices and payers to better understand how a Comprehensive Primary Care Payment may be implemented. Physicians and payers can now explore new options for developing PCMH payment frameworks and/or replace existing capitation and FFS contracts.

The CPCP Calculator is a work in progress, meant as a starting point for discussion with your practice and with payers and employers. It is one example of how health plans and physicians might deploy a CPCP payment. We encourage and expect that stakeholders will modify the proposed methodology for specific markets and contractual relationships.

In order to build a working CPCP model, the team researched current primary care reimbursement models. Then a document detailing the CPCP methodology approach was created. The team invites you to use the Calculator and welcomes your feedback.

See here how to work with the Calculator and User Guide.

See here how to review the Background Research Report and Methodology.

To send us your thoughts and feedback, contact us at strategy@fmahealth.org

Legal Disclaimer:Information provided in connection with this calculator by FMAHealth and its contributors is not a suggestion, invitation, direction or recommendation with respect to what you should charge or what your reimbursement rates should be for your services. Those determinations must be made by each physician or practice based on your own costs, patient population, regional and/or practice-specific circumstances, business judgment, negotiations with payers, and other factors within your discretion. This information is intended to increase the quality and availability of care and services for patients and to enhance, not suppress, competition for such services.

Primary Care Innovators Network (PCIN)

The Primary Care Innovators Network (PCIN) is a partnership among Family Medicine for America’s Health (FMAHealth), the Family Medicine Education Consortium (FMEC) and Employer Advantage Health Care Solutions (EAHCS). The PCIN was formed to strengthen the foundation of primary care across the U.S. in ways that help achieve the quadruple aim: Higher quality, lower cost, improved community health and joy in practice for all members of the team, including patients.

The PCIN contributes to strengthening the foundation of primary care by working with self-insured healthcare organizations (non-profit, for-profit and public), and the primary care practices serving their employees. The PCIN works with practices and payers to learn more about, and put into practice, Comprehensive Primary Care Payment solutions using a Direct Primary Care (DPC) approach. DPC practitioners have at times found it challenging to work directly with employers, finding their practices responsible for building their own tracking, reporting and other support systems.

The PCIN partnership helps address these challenges using a two-pronged approach:

  1. Enabling self-insured employers to build the systems and supports needed to provide enhanced primary care solutions in a CPCP framework to their employees
  2. Ensuring that primary care practices working with those self-insured healthcare organizations and their employees have the support they need to provide enhanced primary care solutions in a CPCP framework to those employees.

PCIN Meetings in 2017-18

The PCIN brings practices and payers together to learn more about the value of Comprehensive Primary Care Payment in a number of markets around the country:

  • Pittsburgh, PA – April 17, 2017
  • Washington, DC – June 15, 2017
  • Chicago, IL—October 5, 2017
  • Cleveland, OH—November 9, 2017
  • Dallas, TX – November 30, 2017
  • Seattle, WA – TBD

Learn More about – and Become a Member of the Primary Care Innovators Network

  • Follow the Primary Care Innovators Network on LinkedIn