- Medicare’s Comprehensive Primary Care Initiative (CPCI): This is a pilot program in which Medicare pays its usual visit fees and an extra pmpm fee, which gives some flexibility to primary care practices to lengthen their visits, as well as pay for doctors or team members to be in contact with patients between visits. In return for extra payment, Medicare expects the participating practices to track their quality of care, and reach out to patients with chronic illnesses or those who have been recently hospitalized. For example, practices would need to show that lab tests are up-to-date for people with diabetes or that people who were discharged from the hospital were seen by a primary care doctor in a timely manner. If successful, the Medicare pilot programs, which have been running for four years in seven states, could be quite influential because the Medicare payment structures have historically set precedent for regular insurers.
- Medicaid: Several state Medicaid programs are trying to change the primary care patient experience, as well. For instance, Oregon’s Medicaid has been reorganized into coordinated care organizations, which put all hospital and clinical health care providers under one umbrella and have them work together to treat people and keep them out of the hospital. Medicaid in Oregon may eventually move away from the fee-for-service method of payment.
- Concierge Medicine: A number of practices are innovating without partnering with insurance or payer programs by just charging a pmpm. That gives them incentive to have a lot of phone and email contact with patients, taking as much time as necessary to solve patient problems. These kinds of practices can make sense for people with high-deductible plans.
The Future for Physicians and Patients
The term “patient-centered medical home” is sometimes used loosely to describe the above innovations. The term can also refer to an actual certification that practices can get to show that they do things like track quality of their care and use electronic records.
The hope is that, eventually, being a patient-centered medical home will qualify practices to receive extra payment—resulting in longer visits, care between visits via phone and email, and other benefits.
I’m encouraged by these innovative patient-centered pilot programs, and by innovations in private clinics like mine. But doctors and patients should also advocate for longer visits, as well as phone and email contact outside of regular visits. If serious primary care reforms are successful, in the future, your primary care doctor will seem—and feel—less rushed.
Dr. Stacie Carney is an internal medicine physician who practices at GreenField Health in Portland, Oregon.