Cohen Genna, Duda Nancy, Morrison Lee Katie, Swankoski Kaylyn, Giudice Gillian, Palakal Maya, Mack Caroline, O'Malley Ann S
Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
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Healthc (Amst). 2024 Jun;12(2):100745. doi: 10.1016/j.hjdsi.2024.100745. Epub 2024 Apr 10.
A growing literature documents how primary care practices adapted to the COVID-19 pandemic. We examine a topic that has received less attention-how participants in an advanced alternative payment model perceive the model influenced their ability to meet patients' care needs during the pandemic.
Analysis of closed- and open-ended questions from a 2021 survey of 2496 practices participating in the Comprehensive Primary Care Plus (CPC+) model (92% response rate) and a 2021 survey of 993 randomly selected primary care physicians from these practices (55% response rate). Both surveys asked whether respondents agreed or disagreed that they or their practice was "better positioned to meet patients' care needs during the coronavirus pandemic" because of participation in CPC+. Both also included an open-ended question about CPC+'s effects.
Half of practices and one-third of physicians agreed or strongly agreed that participating in CPC+ better positioned them to meet patients' care needs during the pandemic. One in 10 practices and 2 in 10 physicians, disagreed or strongly disagreed, while 4 in 10 practices and slightly more than half of physicians neither agreed nor disagreed (or, for physicians, didn't know). The most commonly identified CPC+ activities that facilitated meeting patient care needs related to practices' work on care management (e.g., risk stratification), access (e.g., telehealth), payment outside of fee-for-service (FFS), and staffing (e.g., supporting care managers).
Most CPC+ practices and physicians were positive or neutral about participating in CPC+ in the context of COVID-19, indicating more benefit than risk to payment alternatives to FFS.
越来越多的文献记录了基层医疗实践如何适应新冠疫情。我们研究了一个较少受到关注的主题——参与先进替代支付模式的参与者如何看待该模式对他们在疫情期间满足患者护理需求能力的影响。
对2021年参与“综合初级保健加强版”（CPC+）模式的2496家医疗机构（回复率92%）的封闭式和开放式问题进行分析，并对这些机构中随机抽取的993名初级保健医生进行2021年调查（回复率55%）。两项调查都询问了受访者是否同意或不同意由于参与CPC+，他们或他们的机构“在新冠疫情期间更有能力满足患者的护理需求”。两项调查还都包括一个关于CPC+影响的开放式问题。
一半的医疗机构和三分之一的医生同意或强烈同意参与CPC+使他们在疫情期间更有能力满足患者护理需求。十分之一的医疗机构和十分之二的医生不同意或强烈不同意，而十分之四的医疗机构和略超过一半的医生既不同意也不反对（或者，对于医生来说，不知道）。最常被提及的有助于满足患者护理需求的CPC+活动与医疗机构在护理管理（如风险分层）、就医渠道（如远程医疗）、按服务收费（FFS）之外的支付方式以及人员配备（如支持护理经理）方面的工作有关。
在新冠疫情背景下，大多数参与CPC+的医疗机构和医生对参与CPC+持积极或中立态度，表明FFS支付替代方案的益处大于风险。
