Two-Year Costs and Quality in the Comprehensive Primary Care Initiative

Dale, Stacy; Ghosh, Arkadipta; Peikes, Deborah; Day, Timothy; Yoon, Frank; Taylor, Erin Fries; Swankoski, Kaylyn; O’Malley, Ann S.; Conway, Patrick H.; Rajkumar, Rahul; Press, Matthew J.; Sessums, Laura L.; Brown, Randall

doi:10.1056/nejmsa1414953

Cited by 82 publications

(97 citation statements)

References 20 publications

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“…Our meta-analysis did not include data from recent large-scale PCMH interventions from the Centers for Medicare and Medicaid Services or the Department of Veterans Affairs, because these data became available after we had identified eligible studies for our meta-analysis. 44–46 It is uncertain how our results would have been affected if we had included these data.…”

Section: Discussionmentioning

confidence: 98%

Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief

et al. 2017

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The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures. The initiatives were associated with a 1.5 percent reduction in the use of specialty visits and a 1.2 percent increase in cervical cancer screening among all patients, and a 4.2 percent reduction in total spending (excluding pharmacy spending) and a 1.4 percent increase in breast cancer screening among higher-morbidity patients. These associations were significant. Identification of the components of PCMHs likely to improve outcomes is critical to decisions about investing resources in primary care.

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Section: Discussionmentioning

confidence: 98%

Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief

et al. 2017

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“…Innovative practices that complement primary care actions are transforming care (14) . However, there is greater concern with performing measures for increasing the knowledge on periodic evaluation of eye health.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the self-eye examination method for health promotion

Lima

Nascimento²,

Silva

et al. 2018

Rev. esc. enferm. USP

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Objective:To evaluate the self-eye examination practice as a tool to promote the ocular self-evaluation. Method: Quasi-experimental study developed in a university of Piauí with sample of 324 students between January and May 2014. A team of thirteen researchers made observations during the self-examination followed by an ocular screening. Results: There was no agreement on the hypothesis of defense that the ocular exam could help to observe the eyes health, p-value>0.3. However, the exam was considered as easy to accomplish (99.7%) and that not only the physician can perform the eye exam (99.4%). The awareness about eye care is identified as the main purpose of this booklet (97.6%), (χ 2 = 186.01; p=0.001). The results highlight the booklet can be used in the teaching process of self-eye examination (84.6%). Although the defense that its fulfilment can replace the consultation with the ophthalmologist (23.8%%) cannot be accepted (χ 2 = 46.34), the self-exam must be done routinely (82.4%). Conclusion: The results prove that the learning through virtual booklet is possible and supports self-care with the eyes by performing the self-exam.

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“…24 Similarly, the multistate, multipayor Comprehensive Primary Care Initiative revealed progress in transforming primary care delivery and generating positive provider/payor feedback, while failing to demonstrate significant savings in expenditures or quality by the end of second and third year reporting. 25 This outcome was felt to be promising enough to support a Comprehensive Primary Care Plus (CPCϩ), which offers primary care practices in 18 states or regions a risk-adjusted, monthly Care Management Fee and a Performance-Based Incentive Payment, in addition to traditional FFS. CPCϩ also supports practice transformation with the goal of enhancing key comprehensive primary care functions: 1) access and continuity, 2) care management, 3) comprehensiveness and coordination, 4) patient and caregiver engagement, and 5) planned care and population health.…”

Section: Advancing Primary Care Through Apms In the United Statesmentioning

confidence: 99%

Advancing Primary Care Through Alternative Payment Models: Lessons from the United States & Canada

et al. 2018

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The United States and Canada share high costs, poor health system performance, and challenges to the transformation of primary care, in part due to the limitations of their fee-for-service payment models. Rapidly advancing alternative payment models (APMs) in both countries promise better support for the essential tasks of primary care. These include interdisciplinary teams, care coordination, self-management support, and ongoing communication. This article reviews learnings from a 2017 binational symposium of 150 experts in policy and research that included a discussion of ongoing APM experiments in the United States and Canada. Discussions ranged from APM challenges and successes to their real and potential impact on primary care. The gathering yielded many lessons for policy makers, payors, researchers, and providers. Experts lauded recent APM experimentation on both sides of the border, while cautioning against the risk of "pilotitis," or developing, implementing, and evaluating new payment models without plan or ability scale them into broader practice. Discussants highlighted the power of "learning at scale," highlighting large-scale primary care payment innovations launched by the US Center for Medicare and Medicaid Innovation since 2011, and called for a similar national center to drive innovation across provincial health systems in Canada. There was general consensus that altering payment models alone, absent incentives for innovation and continuous learning as well as increased proportional spending on primary care overall, would not correct health system deficiencies. Participants lamented the absence of more robust evaluation of APM successes and shortcomings, as well as more rapid release of results to accelerate further innovation. They also highlighted the importance of APMs that include flexible and upfront payments for primary care innovations, and which reward measuring and achieving global rather than intermediate outcomes, to achieve utilization goals and patient and provider satisfaction. (J Am Board Fam Med 2018;31:322-327.)Near neighbors and sibling nations in history and trade, the United States and Canada also share a history of poor health system performance, resulting in part from the limitations of fee-for-service (FFS) payment.

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Two-Year Costs and Quality in the Comprehensive Primary Care Initiative

Cited by 82 publications

References 20 publications

Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief

Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief

Evaluation of the self-eye examination method for health promotion

Advancing Primary Care Through Alternative Payment Models: Lessons from the United States & Canada

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