September 4, 2024

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 19 One of the main objectives of primary care and within value-based payment models is to improve patient outcomes and reduce the cost of care.  The top 8-10% of the population consumes about 80% of the healthcare dollar in the United States.  The highest risk patients on every primary care clinician’s panel are those with complex medical, psychological and social needs. In the current fee-for-service paradigm, many health systems, insurers and ACO’s have moved nursing resources from direct clinical nursing to care management roles to try to assist this highly vulnerable population.  However, care (or case) management has often grown out of inpatient nursing departments, moving to transitional care management (to prevent readmissions) and now are trying to perform in outpatient settings with very mixed levels of success. We have observed and scrutinized a number of care management services, and we see several common themes that we feel need to be addressed if we are to truly have an impact on improving patient outcomes AND retain skilled, caring nurses to perform this vital service.  We will dissect these in a series of blogs to dig deeper into the issues that many if not most care management services face. Kathleen Dalton, RN, CCM, CMGT-BC [email protected] Michael Tuggy, MD [email protected] Scott Conard, MD                 Susan Lindstrom                 Laurence Bauer, MSW, MEd [email protected]        [email protected]       [email protected]