Primary Care Collaborative Takes Action to Change Payment Systems

At an April 16 stakeholders meeting here, the Patient-Centered Primary Care Collaborative, or PCPCC, of which the AAFP is a founding member, unveiled four project centers it has formed to integrate the patient-centered medical home into public and private payer systems.

The four project centers will individually concentrate on:

The individual centers are tied together by a common goal: to try to realign the nation's health care payment system to support primary care and the patient-centered medical home. The payment issue is the driving force, because the current payment system does not support the medical home model, according to AAFP President Jim King, M.D., of Selmer, Tenn. "We are going to have to determine how to pay for (the medical home) because we cannot continue to be paid under the present formula and expect to get a medical home," he said at the stakeholders meeting.

Leaders in the business and health care fields head the individual centers, which gives the centers the expertise, experience and authority to direct change. For example, John Agwunobi, M.D., M.B.A., M.P.H., president for professional services at Wal-Mart, is co-chair of the Center for e–Health Information Exchange and Adoption. From December 2005 to September 2007, he served as HHS assistant secretary for health.

Agwunobi notes that Wal-Mart joined the coalition because, as a large pharmacy provider, the company "strongly believes the future has to involve accelerating the adoption of electronic prescriptions." As a member of the collaborative, the retail giant "recognizes that an important part of our effort has to be in promoting the patient-centered medical home."

That is why the Center for e–Health Information Exchange and Adoption is attempting to "inject simplicity and value into health care" by promoting interoperability and portability in terms of health information and data, said Agwunobi.

One of the most immediate goals of the center is to make sure a person's relative health status can be accessed when needed at the primary care level from a variety of sources, including pharmacies, clinical labs, retail clinics, hospitals and other health care providers, said David Nace, M.D., vice president and chief medical officer at McKesson Health Solutions and co-chair of the center.

The Center for Multi-Stakeholder Demonstrations, meanwhile, is in the process of creating a shareholder's group to share information and best practice modalities on how to integrate patient-centered medical homes into public and private payer systems.

At the same time, the Center to Promote Public Payer Implementation is trying to engage all public payer institutions -- Medicaid, Medicare and the Veterans Administration -- that could possibly integrate the patient-centered medical home into their respective systems.

The PCPCC has created a "true opportunity" for the patient-centered medical home within the nation's Medicaid programs by establishing a definition for the medical home and putting forth a set of goals for officials to rally around, said Neva Kaye, senior program director for the National Association for State Health Policy and a member of the Center to Promote Public Payer Implementation. "If payers are all pulling in the same direction, we are probably going to get a lot further. This just gives us the opportunity to do that."

The PCPCC's Center for Benefits Redesign and Implementation has taken some of the most concrete actions to date by developing a draft guide (12-page PDF; About PDFs) for employer purchasers of health care. The document lays out six strategies for advancing the patient-centered medical home in provider agreements:

"We are excited about this initial draft because it addresses the many health benefit variations exhibited by purchasers, while tackling some issues of the patient-centered medical home structure that purchasers need to consider," said Dennis White, vice president of the National Business Coalition on Health, which is developing the guide.