Risk-adjusted base payments can support the move to value

The following PCMH outcomes can be found on page 3 of this report: 

In 2009, a regional health plan in upstate New York undertook a pilot project using a risk-adjusted base payment model. Three of the health plan’s primary care practices volunteered to adopt a patient centered medical home (PCMH) model and accept these types of risk-adjusted payments. The plan’s goal was to compensate the practices for additional activitiesthat can improve care coordination, reduce emergency department (ED) visits and avoidable hospitalizations, and improve compliance with clinical guidelines. Success was measured across three dimensions: patient satisfaction, HEDIS quality scores, and appropriate utilization.
At the end of the first year, the practicessawsignificantresults:

  • Per member, per month costs decreased by $32.
  • Hospital admission rates fell by 24 percent.
  • Admissions for ambulatory-care-sensitive conditions were reduced by 20 percent.
  • Imaging services dropped by 18 percent.
  • ED visits decreased by 9 percent.

Patientsatisfaction was high, and total primary care provider compensation increased significantly. The pilot was so successful that the plan expanded its PCMH modelwith risk-adjusted base payments to additional primary care practices.

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