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Innovative Care Models FAQs

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What type of payment model would best support the PCMH?

The major primary care physician groups and the PCPCC believe that the most effective way to re-align payment incentives to support the PCMH would be to combine traditional fee-for-service for office visits with a three part model that includes: A monthly care coordination payment ("bundled care coordination fee") for the physician and non-physcian work that falls outside of a face-to-face visit and for the system infrastucture (e.g. heath information technologies) needed to achieve better outcomes. Bundling of services into a monthly fee removes volume- based incentives and promotes efficiency. The prospective nature of the payment recognizes the up-front costs to maintain the required level of care. Care coordination payments should be risk-adjusted to ensure that there are no inherent incentives to avoid the treatment of the more complex, costly patients. In addition, this payment component should reflect the level of the practice's service capability based on the NCQA PPC-PCMH recognition process. A visit-based fee-for-service component that recognizes visit-based services that are currently paid under the present fee-for-service payment system and maintains an incentive for the physician to see the patient in an office-visit when appropriate. A performance-based component that recognizes achievement of quality and efficiency goals.

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