The health care system is increasingly moving away from volume-driven, fee-for-service (FFS) reimbursement and toward value-based payment (VBP) models that incentivize quality, enhance the patient experience, and reduce costs. While VBP is increasingly being adopted in Medicaid managed care, significant opportunities remain for states to expand the use of primary care-specific VBP models to support advanced primary care strategies that promote more effective, efficient, and equitable care.
This webinar, made possible by The Commonwealth Fund, explored how state and health plan payers can develop primary care VBP models that promote health equity and support the capabilities of advanced primary care. The 60-minute event included perspectives on: (1) creating a VBP program focused on reducing health disparities in a primary care setting; and (2) implementing a global payment model at the provider level to support enhanced primary care.
I. Welcome and Introductions
Speakers: Rob Houston, MBA, MPP, Director, Payment Reform, CHCS
R. Houston welcomed participants and introduce the webinar topic.
II. State Approaches for Supporting Value-Based Payment in Primary Care
Speaker: Kelsey Brykman, MS, Senior Program Officer, CHCS
K. Brykman provided an overview of state strategies for implementing primary care VBP in Medicaid and highlighted key opportunities for innovation.
III. Leveraging VBP Models to Reduce Health Disparities
Speaker: Len Nichols, PhD, Emeritus Professor of Health Policy at George Mason University and a non-resident Fellow at the Urban Institute Health Policy Center
L. Nichols discussed his experience designing and implementing a VBP program intended to reduce primary care-related health disparities in safety net clinics in Fairfax County, Virginia. He shared how the program was designed, its outcomes, and additional lessons for promoting health equity through VBP.
IV. Implementing Prospective Payment Models to Advance Primary Care
Speaker: Anthony Marinello, MD, Chief Medical Officer, Capital District Physicians’ Health Plan and Adetutu Adetona, MD, Family Physician, Lansingburgh Family Practice
Dr. Marinello provided an overview of the Capital District Physicians’ Health Plan’s (CDPHP) Enhanced Primary Care program, which includes a risk-adjusted global payment model, including program outcomes. Dr. Adetona, a primary care provider in CDPHP’s Enhanced Primary Care program, shared a provider perspective on transitioning from fee-for-service payment to prospective payment. She addressed the benefits and challenges of adopting VBP in her practice.
V. Moderated Q&A
Moderator: Kelsey Brykman, CHCS
Presenters answered questions from attendees about what opportunities exist for states, managed care organizations, and providers to implement primary care value-based payment models.
VI. Wrap Up and Next Steps
Speaker: Rob Houston, CHCS
R. Houston summarized the webinar and give a preview of upcoming sessions.