Peikes Deborah, Taylor Erin Fries, O'Malley Ann S, Rich Eugene C
Deborah Peikes ( dpeikes@mathematica-mpr. com ) is a senior fellow in the Health Policy Assessment division of Mathematica and is located in Princeton, New Jersey.
Erin Fries Taylor is a vice president and managing director of the Health Policy Assessment division of Mathematica and is located in Washington, D.C.
Health Aff (Millwood). 2020 Mar;39(3):421-428. doi: 10.1377/hlthaff.2019.01430.
Providing high-quality primary care is key to improving health care in the United States. The Affordable Care Act sharpened the emerging focus on primary care as a critical lever to use in improving health care delivery, lowering costs, and improving the quality of care. We describe primary care delivery system reform models that were developed and tested over the past decade by the Center for Medicare and Medicaid Innovation-which was created by the Affordable Care Act-and reflect on key lessons and remaining challenges. Considerable progress has been made in understanding how to implement and support different approaches to improving primary care delivery in that decade, though evaluations showed little progress in spending or quality outcomes. This may be because none of the models was able to test substantial increases in primary care payment or strong incentives for other providers to coordinate with primary care to reduce costs and improve quality.
提供高质量的初级保健是改善美国医疗保健的关键。《平价医疗法案》强化了对初级保健这一新兴重点的关注，将其作为改善医疗服务、降低成本和提高医疗质量的关键杠杆。我们描述了过去十年中由医疗保险和医疗补助创新中心（由《平价医疗法案》设立）开发和测试的初级保健服务体系改革模式，并反思了关键经验教训和尚存的挑战。在这十年里，对于如何实施和支持改善初级保健服务的不同方法，我们已经取得了相当大的进展，尽管评估显示在支出或质量结果方面进展甚微。这可能是因为没有一个模式能够测试初级保健支付的大幅增加，也没有对其他提供者与初级保健进行协调以降低成本和提高质量的有力激励措施。
