Advanced primary care focusesmore on quality of care and patient outcomes, as opposed tophysicians being forced to rely on patient volume to meet financialneeds. (Photo: Getty)

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The health care industry has slowly been pushing away from thetraditional "fee for service" model over the past several years,embracing outcome- and value-based payment models. Now, with manyhealth care providers struggling financially and in danger of closingpermanently amid the COVID-19 pandemic, the need for a new model isever more apparent.

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As such, the American Academy of Family Physicians (AAFP) andNational Alliance of Healthcare Purchaser Coalitions have come together to collaborate and create anew set of standards for physicians and purchasers to change howcare is delivered and paid for.

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Related: Fee-for-service is the crack cocaine of healthcare

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"Due to COVID-19 primary care practices are on life support,"Elizabeth Mitchell, president and CEO, Pacific Business Group onHealth, said in a press release. "Employers know that primary careis essential to a healthy workforce. Businesses believe now is thetime to take action and harness the lessons learned from thepandemic to fundamentally reorganize primary care and reinvent ourhealth system."

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PBGH is one of several employer groups joining the effort, thefirst of its kind between a primary care organization and employercoalition. The collaboration will build on the principles ofadvanced primary care (APC), which focuses moreon quality of care and patient outcomes, as opposed to physiciansbeing forced to rely on patient volume to meet financial needs.

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"There are good examples across the country of highly effectivepractices that deliver superior results for both patients andemployers today," said Christopher Crow, MD, president of CatalystHealth Network, which includes nearly 1,000 primary care providersin Texas. "Our ability to partner with employer coalitions at aregional level will be critical to accelerate the proper financingmodel to enable primary care delivery to help our communitiesthrive with improved health and well-being."

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Direct primary care, a subscription-based model in whichconsumers pay a monthly fee for access to physician appointmentsand basic services, is one such example of APC that has beengrowing in popularity in recent years.

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Various Blue Cross Blue Shield affiliates have also been movingaway from the fee-for-service model during the pandemic, "pre-paying" independent health systems forcare and providing a financial lifeline for many independentpractices. Most recently, BCBS of Massachusetts announced the launch of avalue-based payment pilot program for independent primary carephysicians. A pool of money will be distributed to primary carepractices based on the number of patients they serve to be spent asthe practice sees fit on improving patient health. Incentivepayments will also be available for hitting specific qualitytargets.

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"We want to extend our nationally recognized value-based paymentapproach—which rewards providers for the quality of the patientcare they deliver instead of the quantity of tests and health careservices they provide—to more clinicians along the health carecontinuum," said Blue Cross Senior Vice President of NetworkPayment Innovation and Contract Management Matthew Day. "By doingso, we hope to help more of our members reap the benefits of thismodel regardless of where they seek care."

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Emily Payne

Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.