“We need to create a payment system that enables primary care to serve as the efficient and valued foundation of a high-functioning health system. The CPC initiative may be overly constrained by the limits of its investment and its reliance on fee-for-service payment, while the Rhode Island model may provide the right amount of resources but may be constrained by its use of fee-for-service as the base payment structure."

This spring the Health Affairs Blog took a look at two large-scale primary care efforts: the Center for Medicare and Medicaid Innovation's (CMMI) Comprehensive Primary Care Initiative and the state of Rhode Island's payment innovation model.

Investment In Primary Care Works

CMMI showed that primary care can be revenue neutral or drive modest savings. They achieved this through an initial average per-member-per-month payment increase of $20 to support primary care.

Rhode Island took things a step further. They committed to providing primary care through patient-centered medical homes. This managed care approach resulted in a 250% return on investment. Reduced hospital admissions and readmissions drove the savings.

These two large-scale examples prove the viability of a primary care approach. The only problem is funding, especially for smaller entities.

Fee-For-Service Isn't An Adequate Funding Mechanism For Most

Both CMMI and Rhode Island built their primary care programs on fee-for-service models. Because the CMMI invested less because they didn’t increase costs, their ROI was smaller, whereas Rhode Island saw huge returns.

There are cold hard facts though. Using a fee-for-service model, most businesses and public entities won't have the funds or volume of patients to make the necessary investment to transition to a primary care model. They don't have the necessary patient base or scale.

Is Value-Based Primary Care Funding The Answer?

Health Affairs suggests that paying fees based on the quality of care may be the answer. On a large scale, this could be true. Paying providers based on the value of their care would likely drive quality. This approach leaves one question unanswered. How can smaller entities like businesses make the up-front investment needed using this model?

Our model charges a per-employee fee, regardless of whether they use our the clinic as not. This approach provides the capital needed to develop a patient-centered medical home. The ROI is then dependent on employee participation, for which we’ve built a comprehensive engagement program that’s included in our fee. So far, the returns have been good.

What do you think? If we agree that investing in primary care is the foundation of a high functioning health system, how do we invest in it in a way that pays off?

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