▶ Conclusion

The key to sustainability of coordinated care in primary care is panel growth and the ability to take risk—that is, outperform compared to market trends or reduce total medical expense for patients through quality and care coordination. The future care model is sustainable only under alternative payment models and with a commitment to changing people, process, and technology. The highest quality, most cost-effective care must become the easiest path to take for physicians, practice staff, and most important, patients and families. Physician compensation and incentive models must be aligned to facilitate the ability to do the right things with ease while simultaneously achieving value-based contract objectives. Success comes after reaching a tipping point where this becomes the standard care model versus an add-on while also trying to operate under a visit-based fee-for-service model.

Study and Discussion Questions

  1. What is driving the rapid move from volume to value in the U.S. healthcare payment system?

  2. Give examples of types of care delivery services incentivized by volume-based, fee-for-service payment models, as opposed to value-based, alternative payment models.

  3. What are some new skills required of clinicians for success in a future where the bulk of payment may be linked to value?

  4. What are some potential benefits and pitfalls of coordinated care models from the perspective of a provider?

  5. What are some potential benefits and pitfalls of coordinated care models from the perspective of patients?

Suggested Readings and Websites

  1. Publications on care coordination: https://www.commonwealthfund.org/trending/care-coordination

  2. Primary care transformation (Patient Centered Primary Care Collaborative): https://www.pcpcc.org/

  3. Accountable Care Organizations: https://www.naacos.com/

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