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To strengthen primary care, leadership is key
Leadership and the convening of stakeholders, payment incentives, support for infrastructure, information feedback and monitoring, and certification and recognition are key factors for successful delivery system reforms, according to a December 2010 report from The Commonwealth Fund.
The report, Strengthening Primary and Chronic Care: State Innovations to Transform and Link Small Practices, highlighted several state-based initiatives utilizing local and regional strengths to reorganize the delivery of primary and chronic care to produce more efficient and effective care for patients and providers, particularly in small practices.
States can play an important role in helping practices of all sizes to transform, says Anne Gauthier, MS, one of the report's authors and a senior program director for the National Academy for State Health Policy.
They can do this by providing technical assistance and other resources, says Ms. Gauthier. This may include supporting practices in learning new methods of operating, what it means to practice team-based care, how they can be available for after-hours care, and how to improve coordination between the primary care practice and specialty care services.
"No physician wants to practice in a wasteful method. They are there to provide the highest quality care," says Ms. Gauthier. "They may need some assistance in learning how to achieve better quality and be more efficient."
Leadership is a critical element in states that are supporting primary care and helping transform practices, according to Ms. Gauthier. "They are not just looking for ways to save costs. They see clearly that there is evidence that new models of primary care provide better care, and have the potential for lowering costs," she says. "They see that as an investment that is going to pay off over the long term."
New payment models
There are many opportunities in the Affordable Care Act to strengthen primary care, says Ms. Gauthier. These include an increase in payments to Medicaid providers for primary care, training and workforce education funding, and the new Center for Medicare and Medicaid Innovation that will support new primary care models, notes Ms. Gauthier.
New payment models, says Ms. Gauthier, are "particularly exciting for states to take advantage of. The reach of a multipayer pilot, particularly in states with a number of payers or a very dominant private payer like Blue Cross, is that if state and the dominant carrier join together, they can send the same signals to the practices and can share in the cost," says Ms. Gauthier.
One of the paper's case studies reports on Pennsylvania's multipayer medical home program, which was rolled out in stages. "They started in one region and went to another, and as they did that, they learned what was working," says Ms. Gauthier. "One of the things they learned with respect to payment is to offer some shared savings at a fairly early stage in the program. That was very motivational to the practices."
Contact Ms. Gauthier at (202) 903-0101 or firstname.lastname@example.org.