Primary Care Value-based Payment Models

Patient-centered medical homes are one new care delivery concept designed to facilitate communication and shared decision-making between the patient, his/her primary care provider, other providers, and the patient's family.

According to the Agency for Healthcare Research and Quality, the patient-centered medical home encompasses:

1. Comprehensive care that meets the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.
2. Patient-centered care that is relationship-based with an orientation toward the whole person.
3. Coordinated care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports.
4. Accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care.
5. High-quality and safe care with a commitment to quality improvement by ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management.

This voluntary 10-year model aims to strengthen coordination between patients’ primary care clinicians, specialists, social service providers and behavioral health clinicians to prevent chronic disease, reduce emergency room visits and improve health outcomes. The model also plans to engage state Medicaid agencies and private payers. This model will begin in 2024 in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, upstate New York, North Carolina, and Washington.

This model builds upon the Comprehensive Primary Care Plus (CPC+) model, and is offered across 26 regions. Goals of the program include improving quality, augmenting patient experience and reducing expenditures. Participating organizations receive a flat rate payment to support patient centered care and performance adjustment (upside 50% and downside 10%).