Practice Expenses Associated with Comprehensive Primary Care Capabilities.

Area of Science:

• Health Services Research
• Primary Care Medicine
• Health Economics

Background:

• The Centers for Medicare & Medicaid Services (CMS) promotes comprehensive primary care (CPC) through programs like CPC and CPC+.
• Existing fee-for-service models often under-reimburse CPC capabilities.
• There is a need for methods to accurately estimate the costs associated with CPC.

Purpose of the Study:

• To develop and test a method for estimating the practice expenses associated with comprehensive primary care capabilities.
• To inform the design of alternative payment models (APMs) that adequately reimburse CPC.
• To differentiate between variations in costs due to different capability levels versus pricing.

Main Methods:

• A mixed-methods approach was employed, combining interviews with practice leaders and workbook-based cost data collection.
• Fifty diverse primary care practices participated, varying in CPC+ status, geography, size, and affiliation.
• A three-stage process involved initial interviews, detailed cost workbook completion, and final review by practice leaders.

Main Results:

• A method for estimating comprehensive primary care practice expenses was developed.
• Detailed data on practice capabilities and associated costs were collected.
• The study identified a need for larger-scale deployment to quantitatively assess cost variations.

Conclusions:

• The developed cost estimation method can provide robust data for designing new payment models.
• Accurate cost data is crucial for incentivizing and sustaining comprehensive primary care.
• Further research with larger samples is needed to refine APMs for CPC.