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

Jonathan Staloff, Leah M. Marcotte and Joshua M. Liao
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Jonathan Staloff: Value & Systems Science Lab, University of Washington, USA
Leah M. Marcotte: Value & Systems Science Lab, University of Washington, USA
Joshua M. Liao: Value & Systems Science Lab, University of Washington, USA

Management in Healthcare: A Peer-Reviewed Journal, 2020, vol. 5, issue 1, 45-56

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.

Keywords: Medicare; value-based payment; health policy; primary care; primary care reform; alternative payment models (search for similar items in EconPapers)
JEL-codes: I1 I10 (search for similar items in EconPapers)
Date: 2020
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Persistent link: https://EconPapers.repec.org/RePEc:aza:mih000:y:2020:v:5:i:1:p:45-56

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