AAFP wary of advanced alternative payment model for primary care
The formal report observed that many primary care physicians have already begun to adapt to a more integrated model of care, upgrading aspects of coordination as information becomes more widely accessible from a range of resources.
"Aspirational words such as 'patient-centered' and 'whole person' care have returned to the health policy vernacular," the Academy stated.
The AAFP identified five critical principles for advanced APM application, stating that the models must deliver long-term comprehensive care across a range of settings; improve quality, access and outcomes; coordinate actions with primary care teams; support evidence-based care, and function as a “multipayer” model.
The Academy highlighted the designated patient-centered medical home — reporting that 45 percent of its active membership already provides care in such a setting. Noting that the current fee-for-service model is proving obsolete for emergency care, the Academy suggested that PCPs should have a choice of payment systems based on the particular level of emergency care.
"Extending current payment levels into this new delivery model would be a tragedy and disservice to our health care system and every patient," AAFP said.
Regarding advanced primary care, AAFP recommended increasing spending from 6 to 12 percent based on its belief that spending more will result in overall per-patient savings. As a successful example, AAFP cited the state of Rhode Island, where an increase from 5.4 to 8 percent over four years actually led to an 18 percent reduction in total outlay.
"Primary care, by definition, is concerned with delivering patient-centered, longitudinal and coordinated care, and changing such care delivery does not happen quickly," the Academy concluded.