Payment reform to enhance collaboration of primary care and cardiology a review

Steven A. Farmer, Paul N. Casale, Linda Gillam, John S. Rumsfeld, Shari Erickson, Neil M. Kirschner, Kevin De Regnier, Bruce R. Williams, R. Shawn Martin, Mark B. McClellan

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

IMPORTANCE The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care cardiology comanagement of chronic cardiovascular disease (CVD). OBSERVATIONS Few existing alternative payment models specifically address long-Term management of CVD. Primary care medical homes and accountable care organizations come closest, but both emphasize primary care, and cardiologists have often not been well engaged. A collaborative care framework should articulate distinct roles and responsibilities for primary care and cardiology in CVD comanagement. Finally, a series of payment models aim to better support clinicians in providing accountable, seamless, and patient-centered cardiac care. CONCLUSIONS & RELEVANCE Clinical leadership is essential during this time of change in the health care system. Patients often struggle to navigate a fragmented and expensive system, whereas clinicians often practice with incomplete information about tests, treatments, and recommendations by their colleagues. The payment models described in this review offer an opportunity to create more satisfying approaches to patient care while improving value. These models have potential to support more effective coordination and to facilitate broader health care system transformation.

Original languageEnglish (US)
Pages (from-to)77-83
Number of pages7
JournalJAMA Cardiology
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2018

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Cardiology
Primary Health Care
Patient-Centered Care
Cardiovascular Diseases
Delivery of Health Care
Accountable Care Organizations
Fee-for-Service Plans
Quality of Health Care
Home Care Services
Medicare
Health Care Costs
Patient Care
Chronic Disease
Costs and Cost Analysis
Health
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Farmer, S. A., Casale, P. N., Gillam, L., Rumsfeld, J. S., Erickson, S., Kirschner, N. M., ... McClellan, M. B. (2018). Payment reform to enhance collaboration of primary care and cardiology a review. JAMA Cardiology, 3(1), 77-83. https://doi.org/10.1001/jamacardio.2017.4308
Farmer, Steven A. ; Casale, Paul N. ; Gillam, Linda ; Rumsfeld, John S. ; Erickson, Shari ; Kirschner, Neil M. ; De Regnier, Kevin ; Williams, Bruce R. ; Shawn Martin, R. ; McClellan, Mark B. / Payment reform to enhance collaboration of primary care and cardiology a review. In: JAMA Cardiology. 2018 ; Vol. 3, No. 1. pp. 77-83.
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Farmer, SA, Casale, PN, Gillam, L, Rumsfeld, JS, Erickson, S, Kirschner, NM, De Regnier, K, Williams, BR, Shawn Martin, R & McClellan, MB 2018, 'Payment reform to enhance collaboration of primary care and cardiology a review', JAMA Cardiology, vol. 3, no. 1, pp. 77-83. https://doi.org/10.1001/jamacardio.2017.4308

Payment reform to enhance collaboration of primary care and cardiology a review. / Farmer, Steven A.; Casale, Paul N.; Gillam, Linda; Rumsfeld, John S.; Erickson, Shari; Kirschner, Neil M.; De Regnier, Kevin; Williams, Bruce R.; Shawn Martin, R.; McClellan, Mark B.

In: JAMA Cardiology, Vol. 3, No. 1, 01.01.2018, p. 77-83.

Research output: Contribution to journalReview article

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AU - Gillam, Linda

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AU - De Regnier, Kevin

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AU - Shawn Martin, R.

AU - McClellan, Mark B.

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N2 - IMPORTANCE The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care cardiology comanagement of chronic cardiovascular disease (CVD). OBSERVATIONS Few existing alternative payment models specifically address long-Term management of CVD. Primary care medical homes and accountable care organizations come closest, but both emphasize primary care, and cardiologists have often not been well engaged. A collaborative care framework should articulate distinct roles and responsibilities for primary care and cardiology in CVD comanagement. Finally, a series of payment models aim to better support clinicians in providing accountable, seamless, and patient-centered cardiac care. CONCLUSIONS & RELEVANCE Clinical leadership is essential during this time of change in the health care system. Patients often struggle to navigate a fragmented and expensive system, whereas clinicians often practice with incomplete information about tests, treatments, and recommendations by their colleagues. The payment models described in this review offer an opportunity to create more satisfying approaches to patient care while improving value. These models have potential to support more effective coordination and to facilitate broader health care system transformation.

AB - IMPORTANCE The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care cardiology comanagement of chronic cardiovascular disease (CVD). OBSERVATIONS Few existing alternative payment models specifically address long-Term management of CVD. Primary care medical homes and accountable care organizations come closest, but both emphasize primary care, and cardiologists have often not been well engaged. A collaborative care framework should articulate distinct roles and responsibilities for primary care and cardiology in CVD comanagement. Finally, a series of payment models aim to better support clinicians in providing accountable, seamless, and patient-centered cardiac care. CONCLUSIONS & RELEVANCE Clinical leadership is essential during this time of change in the health care system. Patients often struggle to navigate a fragmented and expensive system, whereas clinicians often practice with incomplete information about tests, treatments, and recommendations by their colleagues. The payment models described in this review offer an opportunity to create more satisfying approaches to patient care while improving value. These models have potential to support more effective coordination and to facilitate broader health care system transformation.

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