Achieving Value in Primary Care: The Primary Care Value Model

Abstract

The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation.

How Evolving United States Payment Models Influence Primary Care and Its Impact on the Quadruple Aim

“…107 Already, the health care system pays $15.4 billion annually to measure quality metrics. 108 Early brightspots exist in evaluating some of the attributes of primary care, such as continuity 109 , comprehensiveness 110 , and contact 111 , as well as patient-centered outcomes 19 , but much more work remains in developing those measures and confirm-ing their validity across various populations. 112 We support the recommendations of others for more research to create metrics that effectively measure primary care 113 , health information technology to capture those metrics 114 , and a national organization that validates, disseminates, and implements these measures.…”

“…Such models reward greater numbers of services rendered (ie, volume) rather than the quality and cost of care provided to patients (ie, value). 18,19 Payers, public and private, are experimenting with shifting from paying for volume to paying for value. The Affordable Care Act included provisions that advance primary care and value-based payment, including the creation of the Center for Medicare and Medicaid Innovation (CMMI), which has tested innovative payment and delivery system models aimed at improving value.…”

Evaluation of the Global Payment Program: Midpoint Report

“…After reviewing the main principles of change that are often used to guide safety-net (Sugarman et al, 2014;Wagner, Gupta, and Coleman, 2014) and primary care transformation initiatives (Rollow and Cucchiara, 2016;McNellis, Genevro, and Meyers, 2013) and pilot testing the midpoint survey, we identified six key domains of primary care transformation in which a health system might implement improvement strategies: improving data collection and tracking, improving coordination of care, improving access to care, improving staffing, improving team-based care, and improving the delivery system. In the survey, each PHCS respondent was asked to consider specific improvement strategies associated with each of these six domains by indicating whether that PHCS engaged in the strategy to enhance its response to GPP goals.…”

“It Made a Difference to Me”: A Comparative Case Study of Community Pharmacists’ Care Planning Services in Primary Health Care

“…Demonstrating value in primary health care addresses the triple aim of health systems to improve patient health outcomes, improve patient experience of care, and reduce health care costs [20,21]. Other approaches to show value acknowledge the role of care planning, along with access to care, continuity of care, relationships, evidence-based therapy, and patient engagement in the process [22]. Parameters that may be useful to demonstrate the value of care planning include patients’ experienced health, increased accessibility, building of trust, improved communication with care providers, relationship continuity of patients and care providers over time, information management [23,24], and experiences of health care providers including conditions that support health care providers to find meaning in their work [25].…”