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First things first: Analysing predecessor programmes to glean insights about Medicare’s primary care first programme

Author

Listed:
  • Staloff, Jonathan

    (Value & Systems Science Lab, University of Washington, USA)

  • Marcotte, Leah M.

    (Value & Systems Science Lab, University of Washington, USA)

  • Liao, Joshua M.

    (Value & Systems Science Lab, University of Washington, USA)

Abstract

In 2021, the Centers for Medicare and Medicaid Services plans to launch Primary Care First (PCF), a fee-for-service population-based primary care payment model that will engage primary care practices to assume accountability for the cost and quality of care for aligned beneficiaries. In terms of programme design, PCF progresses from several proposed or implemented predecessor payment models. Organisations considering PCF participation should be aware of how PCF compares to its predecessors and the operational insights that can be drawn from important similarities and differences. This paper addresses these issues by reviewing PCF design, summarising the design and available data from PCF predecessors, and using comparisons to discuss potential implications for PCF performance, including those related to risk adjustment, care management across patient populations, acute care utilisation management, data analytics and accounting and revenue cycle management systems.

Suggested Citation

  • Staloff, Jonathan & Marcotte, Leah M. & Liao, Joshua M., 2020. "First things first: Analysing predecessor programmes to glean insights about Medicare’s primary care first programme," Management in Healthcare: A Peer-Reviewed Journal, Henry Stewart Publications, vol. 5(1), pages 45-56, September.
  • Handle: RePEc:aza:mih000:y:2020:v:5:i:1:p:45-56
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    More about this item

    Keywords

    Medicare; value-based payment; health policy; primary care; primary care reform; alternative payment models;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I10 - Health, Education, and Welfare - - Health - - - General

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