Reimagining a Successful Patient Delivery System

May 11, 2016
Patricia Ingerick, MBA, MSHS / Director of The Geneia Institute


Primary care physicians, challenged with new requirements and expectations under the Affordable Care Act, will need to transform their way of thinking and adopt new models for healthcare delivery if they are to succeed in the post-healthcare-reform era. Embracing this new ideology based on population health and value-based reimbursement will enable PCPs and their practices to benefit from relevant initiatives such as the Comprehensive Primary Care Plus model (CPC+). CPC+ is a new risk-based primary care initiative from the Centers for Medicare and Medicaid Services (CMS) that further emphasizes the importance of primary care in transforming our healthcare system. This program is designed to provide physicians the freedom to choose delivery options within the model as a way of ensuring the best patient outcomes.

The CPC+ initiative includes a monthly, per-patient care management fee and the potential to share in any savings to the Medicare program, in addition to traditional fee-for-service payments. All participating practices will receive up-front incentive payments that the physicians will either keep or repay based on their performance on quality and utilization metrics.

CPC+ is a five-year funding model designed to benefit patients by helping primary care practices:

  1. Support patients with serious or chronic diseases to achieve their health goals
  2. Give patients 24-hour access to care and health information
  3. Deliver preventive care
  4. Engage patients and their families in their own care
  5. Work with hospitals, clinicians and specialists to provide better coordinated care

Primary care practices lucky enough to participate in the CPC+ program will receive education and training, as well as patient cost and utilization data, to help facilitate their practice transformation. However, all primary care practices, regardless of participation in the CPC+ program, still must be open to learning new ways to engage and educate patients and coordinate care.  This novel way of thinking requires care teams to employ new concepts and skills focused on building therapeutic relationships with patients and addressing the social determinants of health.1 To learn more about the CPC+ application process and/or register for informational webinars, visit https://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus

Leaning on elements of Mezirow’s (1997) transformative learning concepts2, one can see how many PCPs are facing what Mezirow calls a ‘disorienting dilemma’ as their reimbursement models are shifting away from fee-for-service to value-based payments.  Wondering how to proceed, PCPs are forced to consider new ways to deliver care to improve the health of their entire patient population. Seeking out education for themselves and their care teams to better understand concepts like population health, care coordination and value-based care is a recommended first step.  Equipped with this knowledge, PCPs can evaluate new ways to practice and build confidence in understanding how a transformed practice might look. Part of this process will be to create an implementation plan to support their care teams through a similar transformative learning process.

A great educational resource for primary care practices is The Geneia Institute where care team members can register for on-demand, skills-based education to meet the changing demands of healthcare. The Geneia Institute team of 200 seasoned professionals, including 100 nurses and physicians, brings a knowledge and expertise grounded in research and applied practices to healthcare organizations and their staff. Another excellent resource is The Geneia Institute’s Care TransformED app, which provides quick access to credible information you need as healthcare professionals from the convenience of your mobile phone or tablet. In addition to accessing The Geneia Institute course catalog, you can pose questions to our experts, such as, “How can my care team learn better patient engagement skills when we don’t have the time or the budget to do so?” Our team of experienced professionals will answer your questions about patient engagement, health literacy and many other topics within 24 hours.

Whether PCPs participate in the CPC+ model or pursue alternate learning resources, such as The Geneia Institute, now is the time to make a decision on how to successfully transform a practice from its current delivery system to one that leverages the concepts of population health and value-based care.


 

References:

1 Rollow, W., Cucchiara, P. (2016). Achieving Value in Primary Care: The Primary Care Value Model.  Annals of Family Medicine.  Vol. 14, 2

2 Mezirow, J. (1997). Transformative Learning: Theory to Practice. New Directions for Adult and Continuing Education, 74, 5–12.


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