Development, Value, and Implications of a Comprehensive Primary Care Payment Calculator for Family Medicine

Abstract

Background and Objectives: Fee for service (FFS), the dominant payment model for primary care in the United States, compensates physicians based on volume. There are many initiatives exploring alternative payment models that prioritize value over volume. The Family Medicine for America’s Health (FMAHealth) Payment Team has developed a comprehensive primary care payment (CPCP) model to support the move from activity- and volume-based payment to performance-based payment for value. Methods: In 2016-2017, the FMAHealth Payment Team performed a comprehensive study of the current state of primary care payment models in the United States. This study explored the features, motivations, successes, and failures of a wide variety of payment arrangements. Results: The results of this work have informed a definition of comprehensive primary care payment (CPCP) as well as a CPCP calculator. This quantitative methodology calculates a base rate and includes modifiers that recognize the importance of infrastructure and resources that have been found to be successful in innovative models. The modifiers also incorporate adjustments for chronic disease burden, social determinants of health, quality, and utilization. Conclusions: The calculator and CPCP methodology offer a potential roadmap for transitioning from volume to value and details how to calculate such an adjustable comprehensive payment. This has impact and interest for all levels of the health care system and is intended for use by practices of all types as well as health systems, employers, and payers.

Heeding the Call for Urgent Primary Care Payment Reform: What Do We Know about How to Get Started?

“…The Payment Tactic Team of Family Medicine for America's Health, an initiative of several family medicine organizations, developed a comprehensive primary care payment calculator that can be used as a starting point for estimating PMPMs for a practice. 31 The calculator builds on the evidence detailed in this brief with added adjustments for quality, efficiency, and infrastructure, with 5 total components: 32 1. Base rate, intended to approximate 10% to 15% of the total cost of care and using the primary care activity levels model.…”

Report From the FMAHealth Practice Core Team: Achieving the Quadruple Aim Through Practice Transformation

“…The Practice Team collaborated with FMAHealth's Payment Team to identify and define the services that should be included in comprehensive care and to show the cost of those services for any geographically-defined population. This work is described in greater detail by The Payment Team (see "Development, Value, and Implications of a Comprehensive Primary Care Payment Calculator for Family Medicine" by Aaron George, DO, et al, in this issue 22 ). Such tools make it possible to determine the proper payment for primary care services and to allow for prospective, periodic payments requiring few administrative strings.…”

FMAHealth: A Work in Progress

“…Their work addresses research capacity, [12][13][14][15] workforce goals, [16][17][18][19][20] and new models of clinical care. [21][22][23][24][25][26] These articles are a sample of the work that has taken place over the course of FMAHealth. There is much to be proud of here.…”