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First things first: Analysing predecessor programmes to glean insights about Medicare’s primary care first programme
In 2021, the Centers for Medicare and Medicaid Services plans to launch Primary Care First (PCF), a fee-for-service population-based primary care payment model that will engage primary care practices to assume accountability for the cost and quality of care for aligned beneficiaries. In terms of programme design, PCF progresses from several proposed or implemented predecessor payment models. Organisations considering PCF participation should be aware of how PCF compares to its predecessors and the operational insights that can be drawn from important similarities and differences. This paper addresses these issues by reviewing PCF design, summarising the design and available data from PCF predecessors, and using comparisons to discuss potential implications for PCF performance, including those related to risk adjustment, care management across patient populations, acute care utilisation management, data analytics and accounting and revenue cycle management systems.
The full article is available to institutions that have subscribed to the journal.
Jonathan Staloff , MD, MSc, is a Family Medicine resident physician at the University of Washington. He also works as a Fellow at the University of Washington Value & Systems Science Lab, where his work focuses on primary care population health payment models. He completed medical school at Brown University. While there he also completed a Masters of Science in Population Medicine and focused his master’s research on physician engagement in Accountable Care Organisations. He has previously worked as a healthcare policy consultant at Avalere Health in Washington, DC, where he worked on healthcare payment and delivery reform.
Leah M. Marcotte , MD, is a primary care physician and Associate Medical Director for Population Health at UW Medicine. She is also a core member of the Value & Systems Science Lab. She completed medical school at the University of Pennsylvania and internal medicine residency at the University of Washington. Previously, she worked in the US Department of Health and Human Services in the Meaningful Use team in the Office of the National Coordinator for Health Information Technology.
Joshua M. Liao , MD, MSc, FACP, is a board-certified internal medicine physician and the Director of the Value and Systems Science Lab in the UW School of Medicine, where he is also an Associate Professor of Medicine. He is also the Medical Director of Payment Strategy at UW Medicine and Adjunct Associate Professor of Health Services in the UW School of Public Health. He completed medical school at Baylor College of Medicine and trained in internal medicine at Brigham & Women’s Hospital, where he was a Clinical Fellow in Medicine at Harvard Medical School. He is a Senior Fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, where he obtained his health policy and economics training. Dr. Liao is a national expert in healthcare payment and delivery policy, advising state programmes, serving as an advisor to the RVU Update Committee (a group that provides recommendations to Medicare about how to value physician work when setting payment rates), and serving as a commissioner on the US Department of Health and Human Services’ Physician-Focused Payment Model Technical Advisory Committee (a group that provides recommendations about payment model implementation to the Secretary of Health and Human Services).