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将初级保健置于首位:医疗保险在基于价值的初级保健方面的最新尝试。

Making care primary: Medicare's latest attempt at value-based primary care.

作者信息

Kumar Wasan, Adashi Eli Y, Kocher Bob

机构信息

Stanford University, School of Medicine, Stanford, CA 94305, United States.

Brown University, Providence, RI 02913, United States.

出版信息

Health Aff Sch. 2023 Dec 4;1(6):qxad072. doi: 10.1093/haschl/qxad072. eCollection 2023 Dec.

Abstract

On June 8th, 2023, the Centers for Medicare and Medicaid Innovation (CMMI) announced the Making Care Primary (MCP) model, its latest attempt to transform primary care delivery for a value-based care payment system. The MCP is a decade-long multi-payer partnership with a voluntary risk-adjusted payment model for primary care organizations. It provides financial support for organizations to develop and implement a value-based care infrastructure and prospective payments per beneficiary for the delivery of primary care. The MCP consists of 3 tracks, ranging from lump-sum infrastructure payments to a fully prospective payment model with 1-sided risk. In turn, physicians need to meet a set criteria, such as quality outcomes, health-related social needs screening and referral, and high-touch chronic care management (CMMI; https://innovation.cms.gov/innovation-models/making-care-primary). While MCP is a well-planned effort, it is likely to suffer from some of the same pitfalls as prior CMS attempts to revolutionize primary care and may therefore exert unintended effects on market consolidation.

摘要

2023年6月8日,医疗保险和医疗补助创新中心(CMMI)宣布了“让医疗回归初级”(MCP)模式,这是其为基于价值的医疗支付系统转变初级医疗服务提供方式的最新尝试。MCP是一项为期十年的多支付方合作项目,采用针对初级医疗组织的自愿风险调整支付模式。它为各组织提供资金支持,以发展和实施基于价值的医疗基础设施,并为每位受益人的初级医疗服务提供预期支付。MCP包括3条路径,从一次性基础设施支付到具有单边风险的完全预期支付模式。相应地,医生需要满足一系列标准,如质量结果、与健康相关的社会需求筛查与转诊,以及高接触式慢性病管理(CMMI;https://innovation.cms.gov/innovation-models/making-care-primary)。虽然MCP是一项精心规划的举措,但它可能会遭遇与美国医疗保险和医疗补助服务中心(CMS)此前革新初级医疗的尝试相同的一些困境,因此可能会对市场整合产生意想不到的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/87af/10986190/23d651b7c20e/qxad072f1.jpg

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