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Primary care transformation is hard. New York State wants to make it easier.

June 26, 2018

    Providers pursue primary care "transformation" to move primary care delivery away from the traditional fee-for-service model and toward a model that supports value-based, patient-centered care. A common first move for provider organizations is to have their primary care practices recognized as Patient-Centered Medical Homes (PCMH).

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    When executed effectively, PCMHs have been associated with improved quality and lower cost of patient care. However, achieving PCMH recognition status can be an expensive undertaking, and provider organizations may lack the technical know-how necessary to implement the model effectively. As a result, many executive leadership teams cannot justify the investment, and they delay care transformation altogether.

    For practices located in the state of New York, those particular pitfalls are about to be addressed.

    How NYSDOH facilitates primary care transformation

    In April, the New York State Department of Health (NYSDOH) announced the New York State PCMH (NYS PCMH) model. Developed with the assistance of the National Committee on Quality Assurance (NCQA)—a national organization responsible for the most common PCMH recognition process—the NYS PCMH model is tailored to meet NYSDOH priorities, and it provides critical assistance to help New York primary care practices to achieve recognition.

    With the range of primary care transformation programs available to primary care practices in the state (i.e., Transforming Clinical Practice Initiative, CPC+, the SIM-funded APC model, and DSRIP-funded initiatives), NYSDOH was struggling to track primary care progress against state goals for care improvement. By working with NCQA, the department was able to modify and add on to PCMH requirements to align them with NYSDOH priorities.

    More importantly for individual practices, NYSDOH has recognized that financial and technical barriers often stand in the way of care transformation. To incentivize practices to move to the NYS PCMH model, the department sought to remove these barriers from the equation in two ways:

    1. NYSDOH will waive practices' first NYS PCMH recognition fee or first annual reporting fee; and
    2. The state will provide participating, physician-led practices with free technical assistance around transformation. NYSDOH has contracted with a number of organizations that specialize in PCMH transformation that will offer practice-specific guidance to facilitate effective care transformation.

    Participate in primary care transformation research

    This year, the Population Health Advisor team is honing in on research around primary care transformation. Early insights confirm that the two major barriers preventing providers from achieving care delivery transformation are funding and data and analytics. While NYSDOH's incentives are well-suited to help organizations start down the path of care transformation, our research indicates that those that have already invested in the PCMH model have slightly different needs when it comes to funding and data. Having secured start-up funding, these organizations must figure out means of sustainable financing, especially while balancing fee-for-service and value-based care contracts. On the data side, issues around interoperability and data integration into practice workflows can hamper further progress beyond medical home recognition.

    If you're interested in participating in this research, we'd love to hear how your organization is tackling these evergreen challenges to drive primary care transformation forward. Please contact Abby Burns at BurnsA@advisory.com.


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