使护理成为基础护理:医疗保险在基于价值的基础护理方面的最新尝试

Wasan M. Kumar, Bob Kocher, Eli Y Adashi
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摘要

2023年6月8日,美国医疗保险和医疗补助创新中心(CMMI)宣布了“初级医疗服务”(Making Care Primary, MCP)模式,这是该机构将初级医疗服务转变为基于价值的医疗支付系统的最新尝试。MCP是一个长达十年的多付款人伙伴关系,为初级保健组织提供自愿风险调整支付模式。它为各组织提供财政支持,以发展和实施基于价值的保健基础设施,并为提供初级保健的每个受益人提供预期付款。MCP包括3个方面,从一次性基础设施支付到具有单方面风险的完全前瞻性支付模式。反过来,医生需要满足一套标准,如质量结果,健康相关的社会需求(HRSN)筛查和转诊,以及高接触慢性护理管理虽然MCP是一个精心策划的努力,但它可能会遭受一些同样的陷阱,因为之前的CMS试图彻底改变初级保健,因此可能会对市场整合产生意想不到的影响。
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Making Care Primary: Medicare’s Latest Attempt at Value-Based Primary Care
On June 8th, 2023, the Centers for Medicare and Medicaid Innovation (CMMI) announced the Making Care Primary (MCP) model, its latest attempt to transform primary care delivery for a value-based care payment system. The MCP is a decade-long multi-payer partnership with a voluntary risk-adjusted payment model for primary care organizations. It provides financial support for organizations to develop and implement a value-based care infrastructure and prospective payments per beneficiary for the delivery of primary care. The MCP consists of 3 tracks, ranging from lump sum infrastructure payments to a fully prospective payment model with one-sided risk. In turn, physicians need to meet a set criteria such as quality outcomes, health-related social needs (HRSN) screening and referral, and high-touch chronic care management.1 While MCP is a well-planned effort, it is likely to suffer from some of the same pitfalls as prior CMS attempts to revolutionize primary care and may therefore exert unintended effects on market consolidation.
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