The Ongoing Evolution of Transforming Primary Care

A message from George Topalsky, MD, Vice President of UH Primary Care Institute

UH Primary Care Institute News | Summer 2019

George Topalsky, MD

There is no doubt that primary care is undergoing a transformation. Health care reform created the impetus for changing the way primary care is delivered, and primary care has been on the forefront of health care reform for 10 years.

Through the concept and application of the patient-centered medical home, we have come to agree that a team-based approach is necessary to fulfill the needs of population health. CMS is very aware that value-based payment is the best immediate solution to both improve the quality and control the cost of health care – and that this is best accomplished through primary care. 

We quickly learned through CMS Comprehensive Primary Care pilots that the use of primary care creates savings and helps achieve improved quality of care for patients. Three years ago, this led to opening up the CPC program to 17 states, under the program name CPC+.The UH Primary Care Institute has participated in this program with two of its practices. We learned how to partner with CMS and how to adapt and make changes within the practice in ways that improve behavioral health and decrease the use of acute care by patients.

The most recent CMS announcement regarding value-based payment programs came two months ago and is an extension of the CPC programs called Primary Care First (PCF). They address quality with a simplified set of quality metrics that we already use; they also address billing overhead through streamlining payment, by creating a single payment amount per visit.  The structure supports the practice with per-member per-month fees, based on the risk stratification of hierarchical chronic conditions. 

The UH PCI, in collaboration with our Population Health leadership, is moving toward creating an Advanced Primary Care “office” that will incorporate longitudinal care, episodic care and pre-visit care. We will begin with deploying this model in 5 primary care offices that allows us to better serve our patients by including the best ideas of the various models. We also want to extend the APC office model to more PCI physician groups that are interested and ready to move toward this transformation. 

It is an exciting moment as the resources and experience of the collective PCI group will help attain the quadruple aim of improved patient quality, improved patient experience, lower cost of care and improved physician/APP experience.