How PCMH Can Help Deliver Value-Based Care

You might have heard “value-based payment” is coming. Well, one thing is becoming increasingly clear in the health care landscape: “value-based payment” has arrived—but, many still don’t believe it.

Last year, Matt Gannon and Jameson King, MPH,  of the New York City Department of Health and Mental Hygiene presented at the PCMH Congress. They worked directly with practices in New York City to help them understand how transforming into a Patient-Centered Medical Home (PCMH) could be an asset in a value-based payment (VBP) environment.

However, there was a bit of convincing that needed to be done. Mr Gannon and Mr King continually heard from doctors and clinicians that “value-based payment is reimbursement, a PCMH is clinical—so they’re not the same thing.”

That’s not exactly true, according to Mr Gannon and Mr King.

“You need to build the same skills to succeed in vale-based payment,” Mr King said during his presentation at PCMH Congress. “They need to have one way to do the right thing.” That way is PCMH transformation.

New York’s Changing Landscape

To do this, the state instituted various programs and goals, including population health-oriented quality improvement programs and a requirement for primary care practices to become recognized by the National Committee for Quality Assurance (NCQA) as a Level 3 PCMH practice by January of 2018. Funding was available to help practices transform.

In addition, the State required 80% of their managed care payments to providers to be made using value-based payment methodologies by 2020.

These changes to New York’s Medicaid program happened around the same time as the Medicare Access and CHIP Reauthorization Act (MACRA), which ties provider payment to value, rather than volume.

With both changes to the overall landscape, practices were incentivized to transform into a PCMH as well as thrive in a value-based payment system. Most practices in New York City are small and nearly half of all NYC patients are covered by Medicare and/or Medicaid.

Mr Gannon and Mr King helped smaller practices in New York City succeed by (1) educating all providers on the reasons behind VBP and demonstrating what it would look like to practices, (2) using PCMH as a value-based framework and aiming for scores of 70+ in MACRA as a result of PCMH transformation and (3) using care management to build skills for addressing total cost of care.

By laying this foundation, small practices could streamline all the changes they needed to make as a result of the various payment changes.

On the Horizon

As more initiatives continue to improve quality and control health care costs in New York and across the country, primary care practices are left to follow Mr Gannon and Mr King’s advice: value-based payment only works if you see the value.

Many practices will discuss the value of patient-centered care in a value-based payment environment at this year’s PCMH Congress. To learn more, visit the web site here.

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