The CPCI will test two models simultaneously: a service delivery model and a payment model. For now, we'll look only at the payment model:
Payment Model. The payment model includes a monthly care management fee paid to the selected primary care practices on behalf of their fee-for-service Medicare beneficiaries and, in years 2-4 of the initiative, the potential to share in any savings to the Medicare program. Practices will also receive compensation from other payers participating in the initiative, including private insurance companies and other health plans, which will allow them to integrate multi-payer funding streams to strengthen their capacity to implement practice-wide quality improvement.Of particular importance here are two things. The first is the care management fee. Do you think PCPs are motivated to take on care coordination? You bet they are! The second is the inclusion of private insurance companies. For those who do little by way of Medicare volume, it's essential to understand that health care reform is not about Medicare alone; it only starts there. The transformation is ubiquitous; it's for every patient, every provider and every payer.
Elsewhere, we'll learn about bundled payments, a new approach to reimbursement that is centered around coordinated care. Coordinated care and the patient-centered medical home are inextricably linked within the CPCI. So we must foresee that, as noted above, the service model and the payment model go hand in hand. Change one and you change the other. Are you preparing for the obsolescence of fee-for-service direct billing? Are you ready to participate in team-based care? Getting ready means EHRs, communications and showing your value as a health care provider to the primary care physicians in your patient catchment area. This is not about stimulus money; it's about scoring winning goals in the new health care game.
Alistair Jackson, M.Ed.
Jim Grue, O.D.
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