PCF Model

PCF clinics are incentivized to deliver patient-centered care that reduces acute hospital utilization (AHU).   PCF is oriented around comprehensive primary care functions: (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and (5) planned care and population health.

Payment to practices are via a simple payment structure, including:

  • Population-based payment (PBP) to provide more flexibility in the provision of patient care along with a flat primary care visit fee; and

  • Performance based adjustment providing an upside of up to 50% of revenue as well as a small downside (10% of revenue) incentive to reduce costs and improve quality, assessed and paid quarterly.

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Strategy Outline

  • Medicare 4-year health history accessible in the EHR (point of care) or via PatientLookup.com

    • Why?

      • HCC Coding Assist, Risk Score, Benchmark, Cost and Utilization at the point of care (View Video Series)

  • Analytics Dashboard using Medicare CCLF claims data (monthly)

  • Track eCQM quality measure performance for Diabetes Hemoglobin A1c (HbA1c) Poor Control (>9%)​, Controlling High Blood Pressure and Colorectal Cancer Screening

    • –Why?

      • eCQM measures must be submitted using a QRDA III file from the EHR.  However, you will want to track year-round performance using CPT II codes, QRDA I and SMART on FHIR to avoid poor performance surprises at end of year.

  • Collect Advance Care Plan (CQM) measure in central qualified registry repository

    • Why?

      • Your PCF organization will be expected to report Advance Care Plan quality measure via a qualified registry or other IT vendor from January – March for the prior year.

      • Data imports used are CPT II codes and SMART on FHIR​