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

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

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

PBGH is one of several employer groups joining the effort, the first of its kind between a primary care organization and employer coalition. The collaboration will build on the principles of advanced primary care (APC), which focuses more on quality of care and patient outcomes, as opposed to physicians being forced to rely on patient volume to meet financial needs.

"There are good examples across the country of highly effective practices that deliver superior results for both patients and employers today," said Christopher Crow, MD, president of Catalyst Health Network, which includes nearly 1,000 primary care providers in Texas. "Our ability to partner with employer coalitions at a regional level will be critical to accelerate the proper financing model to enable primary care delivery to help our communities thrive with improved health and well-being."

Direct primary care, a subscription-based model in which consumers pay a monthly fee for access to physician appointments and basic services, is one such example of APC that has been growing in popularity in recent years.

Various Blue Cross Blue Shield affiliates have also been moving away from the fee-for-service model during the pandemic, "pre-paying" independent health systems for care and providing a financial lifeline for many independent practices. Most recently, BCBS of Massachusetts announced the launch of a value-based payment pilot program for independent primary care physicians. A pool of money will be distributed to primary care practices based on the number of patients they serve to be spent as the practice sees fit on improving patient health. Incentive payments will also be available for hitting specific quality targets.

"We want to extend our nationally recognized value-based payment approach—which rewards providers for the quality of the patient care they deliver instead of the quantity of tests and health care services they provide—to more clinicians along the health care continuum," said Blue Cross Senior Vice President of Network Payment Innovation and Contract Management Matthew Day. "By doing so, we hope to help more of our members reap the benefits of this model regardless of where they seek care."

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Employers, physicians and insurers all moving away from fee-for-service model

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