The California Physicians Group shares insights on how they improved existing payment methodologies in a primary care environment.
Organization Overview: The California Association of Physician Groups (CAPG) is the nation's largest trade association representing physician organizations practicing in the delivery of accountable, clinically integrated health services. CAPG's member groups employ and/or contract with physicians who in turn provide healthcare services to approximately 18 million Californians. More than fifty percent of California's healthcare is delivered by physicians employed by or contracted with CAPG members, who are committed to improving and providing high quality, affordable healthcare for all Californians.
Bio: Wells Shoemaker, MD, is the medical director of CAPG, co-chair of the California Quality Collaborative, and principal in the California Advanced Primary Care Institute (CAPCI). Dr. Shoemaker practiced primary care pediatrics for 25 years before pursuing population health goals in Medi-Cal managed Care, a community IPA, and CAPG. He has a particular interest in health disparities, primary care revitalization, and system supports for frontline practitioners.
Summary: Primary care is the cornerstone for all of CAPG's and all of California's healthcare delivery system. It sets the foundation for virtually every goal of healthcare reform. Sadly, California faces a serious erosion of the primary care workforce at the same time that our state braces for a daunting bulge in chronic illnesses and the long-awaited opportunity to serve millions of previously uninsured individuals and families through reform.
CAPG member groups have long been providing comprehensive primary care, synchronized with specialty and inpatient care. We believe that keeping patients healthy is a cornerstone of ethical care, but coordinated care is the keystone for efficient care. This focus flows in part from our members' structures and payment methodologies. CAPG member medical groups operate under a variety of practice structures, including independent practice associations (IPAs), accountable care organizations (ACOs) and as integrated medical groups. CAPG medical practices identify a population of patients for which they assume responsibility. CAPG groups generally receive an upfront payment amount (typically per member per month) for the population. This payment methodology and alignment of physician goals and incentives allows us to focus on keeping our patients healthy and has made our physicians intensely aware of the importance of good primary care.
As a result, our patients see meaningful benefits. Upfront payments of a defined amount per patient stimulate our use of sophisticated health IT, centrally supported information flow, population awareness, individual care management, measurement and feedback of performance, and use of facilities with a compact for both quality and efficiency. It allows us to deploy primary care teams' physicians, nurses, case managers, and social workers. With each member of the team practicing at the top of his or her license, we pursue the best outcomes for patients while maximizing our practice resources. This approach also has great results for patients, including lowering unnecessary hospital admission rates and emergency department utilization, but more importantly, allowing them to spend more time living their lives, and less time in the hospital.
However, with the onslaught of newly covered lives, aging baby boomers, and drastic change in the marketplace, CAPG strives to reinvigorate its crucial primary care foundation. That is why CAPG helped to create and sustain the CAPCI, a multi-pronged effort to improve the appeal of primary care as a career choice and elevate the performance of primary care teams to respond to the needs of the nation's most diverse population. CAPCI brings together a broad coalition of stakeholders, including the private sector, independent physicians, community clinics, the military and the VA systems, academic teaching centers, health plans, employers, and state and federal government.
Striving to succeed where no previous California effort has succeeded in changing primary care workforce dynamics on a large scale, CAPCI will use an ambitious scope of engagement focusing in four distinct areas, which we call the "Four Ps":
Pipeline - changing the training environment and the appeal of primary care as a career choice for physicians and other clinical professionals.
Practice redesign - practice with team mentality for greater efficiency, better information, modern communication, and central attention to the patient experience.
Payment - aligning payment with modern practices to achieve better care at a lower cost.
Policy - advocating for policy that keeps pace with the developing practice of medicine and enables development of advanced primary care practices.
Previous efforts have failed because they only touched one or two of these key underpinnings and engaged only a subset of the state's interested parties. All Four Ps are needed for primary care revitalization.
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