Innovative Payment for Advanced Primary Care Delivery
Report prepared for the MHMC by Discern Health
Many states have implemented programs that facilitate the transformation of primary care practices to help them become more effective, more efficient, and more integrated into overall healthcare management. Such programs are undertaken with the recognition that primary care is essential to healthcare reform efforts that seek to improve population health. The State of Maine is a national leader in promoting the transformation of primary care. Among the programs that Maine stakeholders have fostered is the multi-payer Maine PCMH Pilot program, which has been successfully facilitating primary care transformation since 2010.
Innovative payment models are a key component of advanced primary care programs. Through these models, practices receive funding to support improvements to infrastructure and care processes, and have incentives to achieve better patient quality and lower overall costs. As Maine stakeholders seek to build on their primary care transformation efforts, they have an opportunity to evaluate, refine, and expand the payment models currently in use in the State. Decisions about which payment models to implement are complex and can have lasting positive or negative consequences for both patients and providers.
The following report outlines various primary care payment models available for consideration in Maine. The report also outlines the various other historical, structural, and policy-based considerations that are critical to payment model design.